内镜置入胆道、十二指肠支架对胆道合并十二指肠恶性梗阻的治疗价值  

Value analysis of combined stents in patients with malignant biliary and duodenal obstruction

作　　者：姜中华 杨红梅 王正江 王翔[2] 沈伟明 吴旭东 王建华 蒋莉莉 许德巧 唐金玲 范志宁[2] 

机构地区：[1]江苏省盐城市第一人民医院消化内镜中心,江苏盐城224006 [2]南京医科大学第二附属医院消化医学中心,江苏南京210029

出　　处：《中国内镜杂志》2015年第5期479-482,共4页China Journal of Endoscopy

基　　金：高等学校博士学科点专项科研基金(No:20123234110003)

摘　　要：目的 探讨经内镜置入胆道支架和十二指肠支架对胆道、十二指肠恶性梗阻的治疗价值。方法 对19例同时存在胆道、十二指肠恶性梗阻的患者经内镜行胆道支架置入后再行十二指肠支架置入,观察手术的成功率、临床症状缓解率、并发症发生情况、支架通畅时间及患者生存期等指标。结果 17例经内镜成功置入胆道、十二指肠支架,2例因内镜逆行胰胆管造影术（ERCP）插管失败改行经皮肝穿刺胆管外引流成功。手术成功率89.5%,临床症状缓解率88.2%,术后恢复经口进食的平均时间（3.5±1.9）d,术前胃出口梗阻中位评分（GOOSS）[1（0-1）分升至2（2-3）分]明显升高（〈0.001）d,中位胆道支架通畅时间85（31-139）d,中位生存时间：91（35~139）d,10（58.8%）例患者再发胆管支架堵塞,3（17.6%）例患者十二指肠支架再发堵塞,患者未出现严重并发症。结论 经内镜联合胆道、十二指肠支架置入治疗胆道及十二指肠恶性梗阻安全有效。[ Objective ] To evaluate curative effects of combined stents in the palliation of malignant biliary and duodenal obstruction. [Methods] A total of 19 patients who underwent duodenal stents after placement of biliary stents due to inoperable malignant biliary and duodenal obstruction were analyzed retrospectively. The technical and clinical success rate of the procedure, overall survival, stent patency, complication rate, etc, were observed. [Results] With technical success rate： 89.7% and clinical rate： 88.2%, combined stents were inserted successfully in 17 patients while 2 patients experienced with percutaneous transhepatic cholangial drainage insteadly for their ERCP failure. After combined stenting, oral feeding was possible at a mean of （3.5±1.9） days, median Gastric Outlet Obstruction Scoring System score （GOOSS） was significantly improved [from 2 （2-3） points to 1 （0-1） point] （P 〈 0.001）; Median patent period of biliary stent was 85days （31-139） days while median survival time from combined stenting was 91days （35-139） days. The obstruction rate of duodenal stents was 17.6% while 58.8% in biliary stents. There were no other serious complications. [ Conclusion ] Combined biliary and duodenal stenting is an effective andsafe method for palliation of malignant biliary and duodenal obstruction.

关 键 词：支架 十二指肠恶性梗阻 胆道恶性梗阻 胰胆管逆行造影术 

分 类 号：R735.9[医药卫生—肿瘤]