抗反流金属支架用于胆道恶性梗阻的可行性研究  

Feasibility of application of anti-reflux metallic stent for malignant biliary obstruction

作　　者：王田田[1] 胡冰[1] 潘亚敏[1] 时之梅[1] 王书智[1] 陆蕊[1] 黄慧[1] 王淑萍[1] 

机构地区：[1]第二军医大学尔方肝胆外科医院内镜科,上海200438

出　　处：《中华消化内镜杂志》2010年第12期632-635,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的 评价抗反流金属支架用于非肝门部胆道恶性梗阻的安全性和有效性.方法 对符合标准的2007年8月至2009年4月诊断为胆总管下段或中段恶性梗阻的患者采用抗反流金属支架进行治疗,记录操作成功率,随访观察早期并发症、支架通畅期和生存期.结果 共有23例无法切除的非肝门部胆道恶性梗阻的患者被纳入研究,均一次性成功置入抗反流金属支架,操作难度与普通自膨式金属支架（SEMS）大致相当,无操作相关并发症.22例患者完成随访,其中20例患者血清总胆红素水平在术后1个月内降至正常水平.有6例患者在随访期内发生支架失效,其中肿瘤组织长入支架腔内1例、超出支架端部2例、支架移位3例;其余患者至随访终点或死亡均未出现胆道症状.抗反流金属支架的中位通畅期为14个月,第3、6和12个月的支架通畅率分别为95.1%、74.2%和55.9%;患者的生存期为1～14个月,平均7.9个月,在术后第3、6和12个月的生存率分别为91.0%、81.3%和17.2%.结论 应用抗反流金属支架治疗低位胆道恶性梗阻在技术上是可行的,并且是安全和有效的.Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent （ARMS） for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duet underwent endoscopic retrograde cholangiopancreatography （ERCP） and ARMs placement. The success rate, early complications, stent patency and patients＇ survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents （SEMs）. In 22 patients completing the fbllow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in-growth in 1, overgrowth in 2, and stent dislodgement in 3. Other patients were free of biliary symptoms until death or at the end of follow-up. The average stent patency of ARMs was 14 months. Patency rates at 3, 6, and 12 months were 95% , 74% and 56% , respectively. The mean patient survival was 7.9 months （ 1-14 months）. Postoperative survival rates at 3,6 and 12 months were 91.0% , 81.3% and 17.2% , respectively. Conclusion Endoscopic placement of novel ARMs in patients with extra-hepatic biliary tumors is feasible, safe and effective.

关 键 词：胆道肿瘤 胆胰管造影术 内窥镜逆行 可膨式金属支架 抗反流 

分 类 号：R735[医药卫生—肿瘤]