肝门部胆管恶性梗阻双侧支架引流

Bilateral endoscopic drainage for malignant hilar obstruction.

目的探讨肝门部胆管恶性梗阻双支架引流的疗效、安全性。方法回顾性分析首都医科大学附属北京友谊医院、北京市消化疾病中心2002年10月至2003年12月22例肝门部胆管恶性梗阻患者双侧支架引流的引流有效率、并发症发生率、支架畅通时间及生存时间。结果22例肝门部胆管恶性梗阻患者均一次植入双支架成功,引流有效率81.8%,并发症发生率22.7%,其中胆管炎4例,胰腺炎1例;中位支架畅通时间113d,中位生存时间138d。结论对于BismuthII、III梗阻型肝门部恶性梗阻,双侧支架引流是安全有效的;对于BismuthIV型,双侧支架引流需慎重。

Objective To explore the efficacy and safety of bilateral endoscopic drainage for malignant hilar obstruction. Methods Retrospectively reviewed the successful drainage rate and complication rate, stent pateney and survival time of 22 malignant hilar obstruction patients treated by bilateral endoscopic drainage from October, 2002 to December, 2003 in Beijing Friendship Hospital. Results Successful stent insertion was achieved in all patients. Successful drainage was achieved in 18 of 22 （81.8%） patients, complications （5/22, 22.7% ） included eholangitis in 4 of 22 patients and pancreatitis in 1 of 22, Median stent patency was 113 days. Median patient survival time was 138 days. Conclusion Bilateral stent insertion is safe, feasible, and achieves adequate drainage in patients with Bismuth type Ⅱ and Ⅲ malignant hilar obstruction, but be prudent for Bismuth type Ⅳ.