经内镜胆道支架置入术姑息性治疗肝门部胆管癌的临床应用  

The clinical application of endoscopic palliative biliary stent implantation for hilar cholangiocarcinoma

作　　者：王庆[1] 秦明放[1] 勾承月[1] 李宁[1] 王震宇[1] 邹富胜[1] 赵宏志[1] 吴喻[1] 

机构地区：[1]天津市南开医院天津市微创外科中心,天津300100

出　　处：《中华腔镜外科杂志（电子版）》2008年第2期85-88,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨经内镜放置胆道支架治疗肝门部胆管癌的可行性及安全性,评价其治疗价值。方法回顾性分析2004年10月～2007年4月72例肝门部胆管癌患者行经内镜胆道支架置入术的成功率、有效率、并发症发生率、支架通畅时间及生存时间。结果BismuthⅠ型4例一次性置入胆道金属支架,BismuthⅡ型以上68例先行内镜鼻胆管引流术(ENBD)过渡引流确定引流效果后,选择合适长度的胆道塑料(ERBD)或金属支架(EMBE)行双侧胆道支架置入术,其中6例行ERBD+ENBD联合内外引流。治疗成功率94.4%,引流有效率83.3%,并发症发生率12.5%,其中胰腺炎2例、胆管炎6例、胆道出血1例、近期死亡2例。支架通畅时间125天,中位生存时间146天。结论对肝门部胆管癌的内镜治疗应根据个体化原则选择不同的治疗方案,在严格掌握适应症及规范操作的基础上,内镜治疗是安全有效解除高位恶性胆道梗阻的微创治疗方法,对中晚期胆道肿瘤患者基本上可替代姑息性胆道手术。Objective To evaluate the safety and feasibility of biliary stent via endoscope in the treatment of hilar cholangiocarcinoma.Methods Retrospective review of 72 patients with hilar cholangiocarcinoma who were treated with endoscopic biliary stents from October 2004 to April 2007 were studied to show the success rate ofinseration、effeciency、the rate of complication、the time ofpatency and survive.Results 4 patients with hilar cholangiocarcinoma of Bismuth I were placed explandable metal biliary stents.via ERCP for only one time;68 patients with other types hilar cholangiocarcinoma were place ENBD firstly and then were placed suitable biliary stents（ERBD or EMBE）when the effect is affirmative,4 patients of these 68 patients were placed both ERBD and EMBE.The success rate was 94.4%;the rate of effeciency was 83.3%;the rate of complication was 12.5%,and PEP occurred on 2 patients,cholangitis occurred on 6 patients,One patient had biliary hemorrhage and two patients were dead in the near future. The median patency was 125-day and the median survival period was 146-day.Conclusions Following the principal of individualization manipulation＇s specification,Endoscopic biliary stent implantation shall be the safe,effictive and mini-invasivc therapy to the patients with hilar cholangiocarcinoma.For the patients with advanced hilar cholangiocarcinoma,this method can displace palliative biliary operation.

关 键 词：内镜 胆道支架 肝门部胆管癌 治疗 

分 类 号：R735.8[医药卫生—肿瘤]