胆肠双支架对胰头癌的姑息性治疗效果初探

The application of combined biliary and duodenal stenting in the palliative treatment of pancreatic head carcinoma

目的探讨胆道内支架和十二指肠金属内支架联合应用治疗胰头癌的价值。方法2003年8月～2005年7月，对4例出现胆道梗阻的胰头癌患者先置入胆道内支架行减黄治疗，当其出现上消化道梗阻症状时，再置入十二指肠金属内支架，观察该治疗方法的疗效。结果4例患者的胆道和十二指肠内支架均一次置放成功。置入胆道内支架后，所有患者的胆红素水平在24h后下降50％左右，1周时均降到正常范围，黄疸消退。当胆道支架堵塞时，行支架置换术或再次置入支架，均成功减黄。置入十二指肠金属内支架后，患者的消化道梗阻症状得到缓解，可进食。当肠道梗阻再发时，再次置入十二指肠内支架。其中1例患者先后共置放3枚十二指肠金属内支架。4例患者均无支架置入术相关并发症发生。死亡2例，其中1例置入支架后生存24个月，1例生存22个月，直至临终均无黄疸及肠梗阻症状；另2例患者仍在随访中，1例置入支架术后16个月，1例9个月，目前均无黄疸及肠梗阻症状。结论胆道内支架联合十二指肠内支架可以明显改善胰头癌患者的生活质量，是一种有效的姑息性治疗方法。

Objective To explore the value of combined biliary and duodenal stenting in the palliative treatment of pancreatic head carcinoma. Methods From August 2003 to July 2005, four patients who were diagnosed as pancreatic head carcinoma presenting obstructive jaundice were treated with biliary stenting. When duodenal obstruction occurred due to the growth of the carcinoma, duodenal stents were placed to relieve the obstruction. Results The biliary and duodenal stents were successfully positioned in all 4 patients. After biliary stents were inserted, the level of total bilirubin value of each patient decreased by 50% in 24 hours and returned to normal range within 1 week. When the biliary stents were occluded, stent replacement or restenting was performed, and relief of obstructive jaundice was thus achieved. After duodenal stents were inserted, the symptoms of duodenal obstruction were relieved and the patients were able to tolerate peroral solid food. When the duodenal obstruction recurred, a second coaxial duodenal stent was inserted. Three duodenal stems were placed in one patient because of rgrowth in size of the carcinoma. No complications related to stenting were observed. Two patients were followed up until their death with survival time of 24 months and 22 months, respectively, who were free of jaundice and duodenal obstruction at the end of their life. Two patients are still in follow-up period （16 months and 9 months after stenting, respectively）, who are now free of jaundice and duodenal obstruction. Conclusion Biliary stenting combined with duodenal stenting can improve the life quality of patients with pan- creatic head carcinoma and is an effective palliative treatment for these patients.