Palliative Therapy with Self-Expanding Partially Covered Metallic Stent for Malignant Esophagojejunal Stricture: Report of a Case

使用部份覆蓋內膜的自膨式金屬支架緩解惡性食道空腸吻合狹窄：一病例報告

林建助(Chien-Chu Lin) ； 蕭吉晃(Chi-Huang Hsiao) ； 李宗熙(Tzong-Hsi Lee)

《臺灣消化醫學雜誌》 23卷4期 (2006/12) Pp. 294-300

https://doi.org/10.6557/GJT.200612_23(4).0002

摘要

近年來，自膨式金屬支架已普遍用來緩解不適合開刀的惡性狹窄，它們可用來緩解食道、膽道、胃出口、小腸、大腸等的急性阻塞。我們報告一例成功緩解48歲男性由鈴胃癌復發造成的急性食道空腸吻合狹窄。此病例先前因為胃癌接受全胃及脾臟切除並做Roux-en-Y的食道空腸吻合手術。三年後發現由於胃癌復發造成食道空腸吻合狹窄，他接受全靜脈營養及數次的化學治療的療程，然而此病人的吞嚥困難反而變的更加嚴重，因此我們放置一支部份覆蓋內膜的自膨式金屬支架經由食道下端經吻合處至輸出端的空腸，成功的緩解食道空腸吻合狹窄。放完此支架後，並無發生吸入性肺炎、出血、及輸入環症候群等併發症。目前病人並與吞嚥困難而且生活品質也有明顯改善長達七個月之久。近年來，自膨式金屬支架已普遍用來緩解不適合開刀的惡性狹窄，它們可用來緩解食道、膽道、胃出口、小腸、大腸等的惡性阻塞。我們報告一例成功緩解48歲男性由於胃癌復發造成的急性食道空腸吻合狹窄。此病例先前因為胃癌接受全胃及脾臟切除並做Roux-en-Y的食道空腸吻合手術。三年後發現由於胃癌復發造成食道空腸吻合狹窄，他接受全靜脈營養及數次的化學治療的療程，然而此病人的吞嚥困難反而變的更加嚴重，因此我們放置一支部份覆蓋內膜的自膨式金屬支架經由食道下端經吻合處至輸出端的空腸，成功的緩解食道空腸吻合狹窄。放完此支架後，並無發生吸入性肺炎、出血、及輸入環症候群等併發症。目前病人並與吞嚥困難而且生活品質也有明顯改善長達七個月之久。

關鍵字

全胃切除 ； 惡性狹窄 ； 金屬支架

並列摘要

Self-expanding metallic stents have been increasingly used for palliation of inoperable malignant strictures in recent years. They have a role in relief of obstruction from esophageal, biliary, gastric outlet, duodenal, and large bowel malignant stricture. We here report a successful palliation for a patient with malignant esophagojejunal stricture due to recurrent gastric cancer He received total gastrectomy with Roux-en-Y esophagojejunostomy and splenectomy for advanced gastric cancer A stricture of esophagojejunal anastomosis was found three years later due to cancer recurrence. He received total parenteral nutrition and several courses of chemotherapy. However the dysphagia progressed under these treatments. We placed a partially covered mesh metallic stent across the stricture from the esophagus to the efferent loop successfully. No complications such as aspiration pneumonia, bleeding or afferent loop syndrome was noted after the stent placement in our patient. Currently, this patient had no more dysphagia and has had good quality of life for seven months.

並列關鍵字

total gastrectomy ； malignant stricture ； metallic stent