超声内镜引导下肠-肠吻合术治疗恶性肠梗阻的应用效果

Application of endoscopic ultrasound-guided enteroenterostomy in treatment of malignant bowel obstruction

摘要:

目的 探讨超声内镜引导下肠-肠吻合术（EUS-EE）治疗恶性肠梗阻（MBO）的效果。方法 回顾性分析2022年6月－2023年12月该院收治的14例因MBO行EUS-EE患者的临床资料。术前采用改良式肠道准备方案行肠道准备，统计分析EUS-EE术后患者症状缓解情况、营养状态改善情况和并发症发生情况。结果 14例均成功实施EUS-EE，选用结直肠梗阻评分系统（CrOSS），评估术前和术后肠梗阻症状和缓解情况，术后1周，CrOSS评分由术前的1至2分上升至2～4分；术后1周，患者主观总体评估（PG-SGA）量表评分为（9.64±3.13）分，明显低于术前的（12.36±3.22）分，差异有统计学意义（t = 2.26，P = 0.032）；术后5例出现体温升高，3例出现气腹，2例出现短肠综合征，经过对症治疗，均得到缓解。术后随访1年内，患者的中位生存时间为81（41，500）ｄ，1年生存率为64.29%。结论 EUS-EE具有症状缓解率高、创伤小和再干预率低等优点。对于基础状况不佳或预期生存时间短的患者，EUS-EE有助于改善身体不适症状，提高患者生活质量，延长生存周期。

Abstract:

Objective To assess the efficacy of endoscopic ultrasound-guided enteroenterostomy (EUS-EE) in the management of malignant bowel obstruction (MBO).Methods Retrospective analysis was conducted on clinical data from 14 patients who underwent EUS-EE for MBO from June 2022 to December 2023. A modified intestinal preparation protocol was employed prior to the procedure, and the resolution of symptoms, improvement in nutritional status, and occurrence of complications were statistically analyzed post-EUS-EE.Results EUS-EE was successfully performed in all 14 cases. The Colorectal obstruction scoring system (CrOSS) was used to evaluate preoperative and postoperative symptom relief and alleviation of bowel obstruction. One week after the procedure, CrOSS scores increased from 1 to 2 before surgery to 2 ~ 4. The patient-generated subjective global assessment (PG-SGA) score for malignancy patients demonstrated a mean score of (9.64 ± 3.13) one week after surgery among the study cohort of 14 patients. This score showed a significant decrease compared to their preoperative PG-SGA score (12.36 ± 3.22), with a statistical difference (t = 2.26, P = 0.032). Postoperatively, five patients experienced elevated body temperature, three had pneumoperitoneum, and two developed short bowel syndrome; However, these complications were effectively managed through symptomatic treatment resulting in recovery or relief thereof . At one-year follow-up, the median survival time was recorded as 81 (41, 500) d with a one-year survival rate at 64.29%.Conclusion EUS-EE offers advantages such as high remission rates for symptoms, minimal trauma, and low reintervention rates. For patients with poor baseline conditions or limited life expectancy, EUS-EE can alleviate physical discomfort symptoms , improve quality of life, and prolong survival period.