反向内镜超声波指导的新胃结节术
1Department of Internal Medicine, University of Minnesota, Minneapolis Minnesota, USA.
概括
以内镜超声波 (EUS) 引导的胃关口术 (GJ) 在结肠插入后成功地管理了缺口的阻塞. 采用反向的方法,使用光线对立金属支架 (LAMS) 改善了结果,并预防了并发症.
科学领域:
- 胃肠病学 胃肠病学
- 干预性内镜检查是干预性的内镜检查.
- 手术瘤学手术瘤学
背景情况:
- 以内镜超声波 (EUS) 为指导的胃肠结节术 (GJ) 为治疗上部胃肠道阻塞的手术提供了一种最小侵入性的替代方案.
- 缺口可以导致出口阻塞,特别是在以前经历过胃外科手术和结肠插入等重建手术的患者中.
研究的目的:
- 描述EUS指导的GJ的新型应用,用于在患有结肠插入的患者中管理因间歇性而导致的出口阻塞.
- 突出反向方法的实用性,使EUS引导的GJ克服技术挑战并提高安全.
主要方法:
- 一名71岁的女性,有全胃切除和结肠插入病史,出现了胃出道阻塞的症状.
- 由于迁移,最初试图支架 colojojeunal 解体器失败;阻塞是由于缺口的外部压缩造成的.
- 进行了EUS引导的新GJ,最初是远端侧错误部署到腹膜. 支架被移除,穿孔被关闭,并使用成功的反向方法.
主要成果:
- 最初试图在EUS引导的GJ使用光线对立金属支架 (LAMS) 导致远端侧翼错误部署到腹膜.
- 在切除支架和关闭穿孔后,成功地进行了反向EUS导向的GJ,LAMS通过穿刺向新胃部推进.
- 口服对比研究证实了支架的通透性,在6个月的随访后,患者仍然没有症状.
结论:
- 错误地将LAMS部署到腹膜中是EUS指导的GJ程序中已知的并发症.
- 以EUS为指导的GJ的反向方法,针对一个不太流动的结构,可以减轻支架位移的风险,并提高程序的成功.
- 以EUS为指导的GJ是一种可行的选择,用于管理先前经过胃外科手术和重建手术的患者的复杂出口阻塞.
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