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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2024, Vol. 12 ›› Issue (02) : 97 -105. doi: 10.3877/cma.j.issn.2095-5782.2024.02.001

专论

胃十二指肠支架置入术
Kun Yung Kim1, 曹家玮2, Ho Young Song3,†(), Jin Young Kim4, 袁航5, 胡鸿涛5, Jin Yoon Chang1   
  1. 1. 463-707　韩国首尔，首尔国立大学医学院盆唐医院放射科
    2. 510627　广东广州，南方医科大学广东省人民医院（广东省医学科学院）微创介入科
    3. 450008　河南郑州，郑州大学附属肿瘤医院（河南省肿瘤医院）放射介入科；138-736　韩国首尔，蔚山大学医学院峨山医院放射科，放射研究所
    4. 138-736　韩国首尔，蔚山大学医学院峨山医院放射科，放射研究所
    5. 450008　河南郑州，郑州大学附属肿瘤医院（河南省肿瘤医院）放射介入科
  • 收稿日期:2024-05-12 出版日期:2024-05-25
  • 通信作者: Ho Young Song
  • 基金资助:
    国家科技部外国专家项目(G2023026016L); 河南省杰出外籍科学家工作室(GZS2022020)

Gastroduodenal stent placement

Kun Yung Kim1, Jiaywei Tsauo2, Ho Young Song3,†(), Jin Young Kim4, Hang Yuan5, Hongtao Hu5, Jin Yoon Chang1   

  1. 1. Department of Radiology, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seoul 463-707, Korea
    2. Department of Interventional Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Guangzhou 510627, China
    3. Department of Interventional Radiology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Henan Zhengzhou 450008, China; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
    4. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
    5. Department of Interventional Radiology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Henan Zhengzhou 450008, China
  • Received:2024-05-12 Published:2024-05-25
  • Corresponding author: Ho Young Song
  • About author:

    Co-first authors: Kun Yung Kim, Tsauo Jiaywei

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引用本文：

Kun Yung Kim, 曹家玮, Ho Young Song, Jin Young Kim, 袁航, 胡鸿涛, Jin Yoon Chang. 胃十二指肠支架置入术[J]. 中华介入放射学电子杂志, 2024, 12(02): 97-105.

Kun Yung Kim, Jiaywei Tsauo, Ho Young Song, Jin Young Kim, Hang Yuan, Hongtao Hu, Jin Yoon Chang. Gastroduodenal stent placement[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(02): 97-105.

胃出口梗阻是晚期胰腺、胃和十二指肠恶性肿瘤的一种晚期并发症。胃出口梗阻患者会出现难治性恶心、呕吐和厌食，进而可能导致电解质失衡、脱水和营养不良。此外，这些患者持续存在误吸和肺炎的风险。传统上，这些梗阻大多采用手术治疗。然而，许多患者由于初始评估时的身体状况不佳而不适合接受搭桥手术。此外，其发病率和死亡率显著较高，并与症状持续或延迟缓解和住院时间延长相关。球囊扩张术和金属支架置入已成功应用于不适合手术的患者。文章将对其适应证、禁忌证、技术、结果及争议进行综述。

关键词: 胃, 十二指肠, 肿瘤, 梗阻, 自膨式金属支架

Gastric outlet obstruction is a preterminal complication of advanced malignancies of the pancreas, stomach, and duodenum. Patients with gastric outlet obstruction experience intractable nausea, vomiting, and anorexia, which may in turn cause electrolyte imbalance, dehydration, and malnutrition. Furthermore, these patients are at constant risk for aspiration and pneumonia. Traditionally, most of these obstructions were treated surgically. Many patients, however, are unfit for bypass surgery because of poor medical condition at initial evaluation. Moreover, it carries a significant rate of morbidity and mortality and is associated with persistent or delayed relief of symptoms and prolonged hospital stay. Balloon dilation, as well as placement of metallic stents, has been applied successfully in patients who are not surgical candidates. In this review article, the indications, the contraindications, techniques, results, and controversies will be discussed.

Key words: Stomach, Duodenum, Neoplasms, Obstruction, Self expandable metallic stents
图1 肠道Wallstent1A：支架从10F输送系统中部分释放，在完全释放之前可以回收至输送系统内；1B：释放的肠道Wallstent具有高度柔韧性。
图2 多种类型的胃十二指肠覆膜支架2A：Niti-S支架由镍钛合金单丝以交错方式编织，覆以聚氨酯膜，两端设计成喇叭形以防止移位，支架近端（口侧）设有绳索，便于内镜下移除（箭头）；2B：HANAROSTENT，该支架由单根镍钛合金丝互锁编织，覆以硅胶膜，其近端设置有裸露部分，帮助防止移位（箭头）；2C：Dual Stent，包括一个裸支架（上）和一个部分覆膜支架（下），计为同轴放置，内部裸支架由镍钛合金丝编织，两端呈喇叭形，外层部分覆膜支架包含3部分：近端和远端裸露的部分（箭头）和中间覆以尼龙膜的部分。
图3 X线引导下胃十二指肠支架置入示意图3A：操作中使用导管和导丝穿过梗阻段；3B：通过注射少量对比剂以显示阻塞的远端位置；3C：尽可能将硬导丝送到远端，随后移除导管，通过硬导丝送入支架输送系统；3D：支架置入后注射对比剂以确保支架通畅。
图4 1例63岁胃癌患者4A：X线片显示1根Song-Lim导管穿过胃窦阻塞（箭头）；4B：将导管送入空肠，随后置入硬导丝；4C：支架输送系统通过硬导丝，支架部分展开（箭头）；4D：支架放置后即刻行造影显示支架部分扩张，支架中心部分被肿瘤压迫（箭头）；4E：术后1 d上消化道造影显示造影剂可以通过支架。
图5 1例82岁胰腺癌患者，内镜与X线结合引导经口支架置入失败5A：经皮胃造口造影显示十二指肠空肠连接处有梗阻（箭头）；5B：经胃造口置入部分覆膜支架（箭头）；5C：支架置入后1天进行上消化道检查显示支架通畅（箭头）。
图6 1名55岁男性因胰腺癌引起的梗阻性黄疸，在胆道支架置入术后7 d出现上消化道梗阻症状6A：经口造影显示十二指肠第二部分梗阻（箭头），虽然导丝能够通过梗阻区（弯曲箭头），但只能通过胆道支架的网眼；6B：为避免导丝误入胆道支架网眼，使用球囊在胆道支架内暂时封堵，随后将导丝和导管通过梗阻区域（箭头）；6C：在硬导丝成功置入空肠后，沿导丝送入支架输送系统（标示箭头）；6D：十二指肠支架置入后1天，上消化道造影确认支架通畅（箭头）。
图7 1名63岁男性胰腺癌患者7A：在裸支架置入90 d后行上消化道造影发现，由于肿瘤通过支架的网眼向内生长，导致支架内管腔狭窄（箭头）；7B：在放置第二枚支架后行上消化道造影显示新支架通畅（箭头）。
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