晚期壶腹周围癌的胆胰管双支架治疗  

Biliary tract prosthesis combined with pancreatic duct stents in patients with periampullary carcinoma

作　　者：韩树堂[1] 史伟[1] 张小琴[1] 张以洋[1] 张其德[1] 肖君[1] 周玉宏[1] 胡余美[1] 姜素峰[1] 

机构地区：[1]南京中医药大学附属江苏省中医院消化病诊疗暨内镜中心,210029

出　　处：《中华消化内镜杂志》2009年第5期253-255,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨晚期壶腹周围癌患者胆管和胰管双支架治疗的临床价值。方法36例经病理学和（或）临床诊断为晚期壶腹周围癌患者，影像学表现为胰管和胆管均有狭窄，经内镜先在胰管内置入Teflon塑料支架，然后胆道内置可膨胀式金属支架，不成功者改经皮经肝胆管内置入金属支架进行引流。观察支架置放前后患者的血清肝生化指标、胰酶水平和临床表现。结果36例置入胰管塑料支架均顺利，29例内镜置人金属胆道支架成功，7例（2例Billroth1I术后）因导丝插入胆管困难改为经皮经肝胆管内支架置入。支架置放后肝ALT、AST、ALP、r-谷氨酰转肽酶以及总胆红素、直接胆红素均有明显的下降；15例出现血淀粉酶和血脂肪酶的升高，但经过治疗后均恢复正常；腹痛缓解率82．4％（28／34），腹泻改善有效率达88．2％（15／17）。结论胆、胰管联合支架可以解除壶腹周围癌患者的胆、胰管恶性狭窄与梗阻，安全有效。Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage （ PTCD ） pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth II gastrectomy. The levels of liver enzymes significantly decreased （P 〈 0. 01 ） after stents implacement. The levels of amylase （plasma and urine） and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82. 4% （28/34） and 88. 2% （ 15/17 ）, respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duet stents is safe and effective in relieving malignant obstruction in periampullary carcinoma.

关 键 词：胆道肿瘤 恶性梗阻 胆管 胰腺管 支架 

分 类 号：R735[医药卫生—肿瘤]