| Objective: In view of the gradual increase in the incidence of malignant gastric outlet obstruction caused by digestive malignant tumor,the success rate and clinical efficacy of endoscopy combined with X-ray fluoroscopy in the treatment of malignant obstruction of gastric exits are discussed.Method: From January 2016 to December 2017,36 cases of malignant obstruction of gastric exits were selected,including 24 cases of gastric cancer,7 cases of pancreatic cancer,3 cases of twelve finger colon cancer,1 cases of gallbladder cancer and 1 cases of recurrence and metastasis of colorectal cancer.Preoperative fasting 1-3D,and the condition of gastrointestinal decompression,ready to improve the posterior endoscopy and through the biopsy hole into the guide wire,combined with X-ray development of self-expanded metal stent.On the day after the operation,the clinical manifestations of complications such as nausea,vomiting,bleeding,pain,displacement,perforation and so on were closely observed.The patients with complications such as hemostasis,analgesia,support treatment,etc.were actively treated.If there is no discomfort,a liquid diet can be opened and gradually transferred to a semi liquid diet.Some patients can return to normal diet.During the follow-up period,the stent stenosis and location of the upper gastrointestinal tract were observed in the upper gastrointestinal tract or gastroscope according to the patients' symptoms,such as recurrent obstruction,stent blockage,displacement and other complications,which could be treated by endoscopy.The stent patency rate,clinical efficiency,average operation,average life period,and follow-up period(14d,1mon,2mons,3mons,6mons)were used for stenting.Results: In 36 cases,42 cases of metal stents were placed with endoscopy combined with metal stents,and 40 metal stents were placed in a total of 40.Among them,2 patientsreceived a large amount of retention in the stomach cavity after entering the mirror.After40 cases of stent implantation,the symptoms of 24 h obstruction were improved in varying degrees.The symptoms of abdominal pain and abdominal distention were relieved,and they were able to eat fluid or half fluid and gradually transition to normal diet.11 cases had a small amount of bleeding during the operation.After spraying with 1:10000 epinephrine,no bleeding was observed in 5min,and no obvious bleeding symptoms were observed after operation.8 patients had different degrees of abdominal pain after operation and could be relieved within 7d after symptomatic treatment.During the follow-up period,5 patients had another symptom of obstruction,2 were endoscopically electrocauterically cauterization of the neoplasm of the stent,and 3 of the metal stents were implanted again on the basis of the original stent.The symptoms of the obstruction were quickly relieved.There were 1 cases of stent displacement during the follow-up to 161 d,and a new stent was replaced at the original obstruction site.No complications such as perforation,gastrointestinal bleeding and other stent related complications occurred during the follow-up period.The success rate of statistical operation was 95.24%,the clinical effective rate was 100%,the average operation time was 32.3 + 16.7min,and the operative time was less than 30min(72.5%)(29/40).The patency rate was97.5%,97.3%,97.2%,96.6%and93.8% respectively after 14 d,1mon,2mons,3mons,and6 mons.The average survival time of the follow-up period was 7.9 months.The survival period was 5 cases for more than 12 months and the longest life period was 16 months.7cases were still alive,5 cases were lost,24 cases died of advanced tumor body failure,and no surgical related death cases were not found.Conclusions: Endoscopic metal stent is a safe and effective treatment method to remove malignant gastric outlet obstruction,stent implantation combined with X-ray fluoroscopy has the advantages of accurate positioning,short operation time,little pain,and one-time placement success rate is high,and has wide clinical application value. |
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