联合X线透视的十二指肠镜下金属支架放置治疗十二指肠中下段恶性梗阻  

Treatment for malignant duodenal obstruction with a metal stent through duodenoscope assisted by X-ray fluoroscopy

作　　者：刘鹏[1] 周会新[1] 吴明浩[1] 杨庆临[1] 李东英[1] 

机构地区：[1]湖南省人民医院消化科,湖南长沙410005

出　　处：《中国内镜杂志》2009年第5期469-471,共3页China Journal of Endoscopy

摘　　要：目的探讨联合X线透视的十二指肠镜下放置金属支架治疗不能手术切除的十二指肠中下段恶性梗阻的方法和临床价值。方法20例患者均有明显的梗阻症状,其中十二指肠肿瘤15例,胰头癌2例、壶腹癌3例,在X线透视监视下,经十二指肠镜置入自膨式金属内支架25枚。结果20例患者全部一次成功置放支架,一次性成功率为100%,操作时间最短20min,最长1.5h,平均40min。5例患者分别置入胆道支架和肠道支架,其中3例分2次放置。置入后梗阻症状缓解,当日即能进软食,1周呕吐消失率100%,腹胀缓解率达85%(17/20)。无严重并发症发生,随访时间2～16个月,患者平均生存4.6个月。结论对于不能或拒绝手术的十二指肠中下段恶性梗阻的患者,经由联合X线透视的十二指肠镜置入金属内支架是安全、有效、创伤小的治疗方法。[Objective] To evaluate the clinical value of interventional treatment for inoperable malignant duodenal obstruction with the insertion of a metal stent through duodenoseope assisted X-ray fluoroscopy. [Methods] Clinical data of 20 patients with symptoms of malignant duodenal obstruction were reviewed, including 15 cases with duodenal tumor, 2 with pancreatic head carcinoma and 3 with ampullary carcinoma. Under X-ray fluoroscopic guidance, 25 metal self-expanding stents were implanted through duodenoscope. [Results] The operations of implantation to 20 patients were all successful at one time. The operation time was in the range of 20 minutes to 1.5 hours, the average time was 40 minutes. Two kinds of metal stents, i.e., biliary stent and intestinal stent, were implanted to biliary tract and duodenum of 5 cases, among which 3 cases accepted the implantation operation twice. Immediate relief of the obstruction was observed after the implantation and all the patients were able to take soft food. No severe complieations occurred. The follow- up period was 2-16 months, and the mean survival time was 4.6 months. [ Conclusion] The implantation of metallie self-expanding stent is a simple, effective and safe treatment for patients with inoperable malignant duodenal obstruction.

关 键 词：十二指肠恶性梗阻 金属支架 十二指肠镜 

分 类 号：R730.56[医药卫生—肿瘤] R735[医药卫生—临床医学]