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目的:评价新型Y型~(125)I粒子金属支架治疗全胃切除术后食管-空肠吻合口狭窄的可行性、安全性和疗效。方法:回顾分析了东南大学附属中大医院2014年8月—2015年5月收治的6例胃癌术后食道-空肠吻合口狭窄患者的临床及影像学资料。首先根据吻合口狭窄的特殊解剖结构病变特点,设计新型Y型~(125)I金属支架治疗。然后在数字减影血管造影(digital subtraction angiography,DSA)下置入新型Y型~(125)I粒子金属支架,并于支架置入后行上消化道造影检查,观察支架通畅情况。最终随访4~18个月,观察患者进食情况。结果:6例患者均一次性成功置入支架,所有患者术后恶心、呕吐及腹胀症状缓解,生活质量均有所提高,无出血、吻合口瘘等并发症发生。术后所有患者均获得完整随访,其中1例患者于支架置入术后5个月死于肺炎;余5例患者生活质量明显提高。结论:通过研究发现Y型~(125)I金属支架不仅可以扩张吻合口狭窄段、解决单管状支架仅能解除输出袢而牺牲输入袢的不良后果,而且能通过携带的~(125)I粒子对吻合口局部复发的肿瘤进行持续低剂量的γ射线治疗。该技术可行,近期疗效可靠,值得进一步推广应用,但尚需大样本随机对照研究进一步验证。
OBJECTIVE: To evaluate the feasibility, safety and efficacy of a new type Y ~ (125) I particle metal stent in the treatment of esophageal-jejunostomy stenosis after total gastrectomy. Methods: The clinical and imaging data of 6 patients with esophageal-jejunostomy stenosis after resection admitted to the Affiliated Zhongda Hospital of Southeast University from August 2014 to May 2015 were retrospectively analyzed. First, according to the characteristics of the special anatomical structure of anastomotic stenosis, a new Y-type 125I metal stent was designed. Then, a new type of Y ~ (125) I particle metal stent was placed under digital subtraction angiography (DSA), and the upper gastrointestinal radiography was performed after the stent was inserted to observe the stent patency. The final follow-up 4 to 18 months, observe the patient’s food intake. Results: All the 6 patients were successfully placed in the stent all at one time. All patients had nausea, vomiting and bloating symptoms, and their quality of life improved with no complications such as hemorrhage and anastomotic fistula. All patients were followed up completely. One patient died of pneumonia 5 months after stent implantation. The quality of life of the remaining 5 patients was significantly improved. CONCLUSIONS: It has been found through research that the Y-125 I stent can not only expand the anastomotic stenosis, but also can overcome the adverse effects of inputting only by releasing the output tube, A sustained low-dose gamma-ray therapy of locally recurrent anastomotic tumors. This technique is feasible and has reliable curative effect in the near future and is worthy of further promotion and application. However, large sample randomized controlled studies are still needed to further verify this technique.