Transcript ppt
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 화순전남대학교병원 영상의학과 혈관조영 & 인터벤션실 *김종학, 김현석, 최연상, 박 혁, 김종덕, 김경묵, 선종백 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Introduction Gastric outlet obstruction Common clinical manifestation in benign or malignant disease of distal stomach, duodenum, and pancreatic area Cause - Gastric and pancreatic carcinoma - Lymphoma - Biliary cancer - Metastasis to duodenum or jejunum - Extrinsic compression Clinical Presentation - Nausea, Vomiting, Malnutrition “Food fear” Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Introduction Malignant Gastroduodenal obstruction Average survival time : 3~4 months Minimally invasive but effective palliation method is required Surgical palliation - Standard palliation method - Associated with high complication rate ; Poor general condition, Malnutrition state Stent insertion Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Introduction Gastroduodenal Stent 1992, Gastroduodenal stent – Bare stent - tumor ingrowth, gronulation tissue formation Restricture 1999, Covered gastorguodenal stent - Migration(21~26%), biliary obstruction Self-expanding separate gastroduodenal stent Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Indications Gastroduodenal Stent Gastric, duodenal, and proximal jejunal malignant obstructions caused by non-resectable tumors Obstruction by recurred lesion after previous surgical anastomosis Benign obstruction patient with surgical risk Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Technique UGI - Useful for identifying length and location of stricture CT - Tumor staging - Provide valuable information concerning location of stricture and possible additional level of obstruction Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 1 ¶ 남 / 77 ¶ 임상소견: No water and food ¶ 진 단 명 : Malignant stomach - Gastroduodenal obstruction Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 1 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 1 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 1 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 1 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 2 ¶ 남 / 70 ¶ 임상소견: No water and food, vomiting ¶ 진 단 명: Gastric cancer-chemotherapy Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 2 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 2 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 2 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 2 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Case 2 Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Consideration • we could know that patient inserted separate gastroduodenal stent could take ingestper oral by removing gastric oulet obstruction, recovered solwly and gained in weight. • Recently endoscopic self-expanding stent has been attempted, but in gastric outlet obstruction disease, we could know that this procedure itself was not achieved because endoscopic approach was difficult. Angiography & Intervention Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰 Conclusion Separate gastroduodenal stent placement is very safe and effective palliation method in patients with unresectable malignant tumors causing gastric outlet obstruction - High technical success rate - Less invasive - More cost effective than surgical prcedure Angiography & Intervention