胆胰管良恶性梗阻的多点位引流治疗

Multi-stenting drainage in treating obstruction of pancreaticobitiary duct

目的探讨通过内镜逆行胆胰管造影术(endoscopic retrograde cholangiaopancreatography,ERCP),同期置入多点位支架以姑息性解除胆胰管良恶性梗阻的操作技术及其临床疗效。方法采用ERCP了解胆、胰管狭窄或梗阻的精确部位、范围、程度,并确定需置入多点位支架。然后在确定的胆、胰管分别置入导丝并逐级扩张狭窄段,然后在导丝引导下按常规分别置入多点位引流支架。术后观察血淀粉酶变化及黄疽、腹痛、腹泻等临床症状的改善情况及支架通畅期。结果28例胆胰管良恶性梗阻患者总有效率(引流满意组加引流一般组)为89.3%。其中,中、低位胆管梗阻者治疗有效率为90.9%,高位胆管梗阻治疗有效率为88.2%。术前6例上腹部胀痛患者,术后2周内2例消失,2例减轻,2例无明显变化;术前3例腹泻患者,术后1个月1例消失,1例明显减轻;有6例术后出现高淀粉酶血症,发生率为21.4%,均在72h内恢复正常;有2例患者术后2周内发生胆管炎,发生率为7.1%。28例病人中恶性梗阻病人多点位支架的平均通畅期为7个月,全组未发生与操作有关的严重并发症及死亡。结论多点位支架引流可扩大胆胰管良恶性梗阻的引流范围,迅速解除黄疸,减压止痛,改善胰腺外分泌功能,并能维持较长的支架通畅期,是一种安全、有效的治疗方法。

[Objective] To study the technique of implanting stents in treating multiple pancreaticobiliary duct obstruction and to assess its clinical effectiveness with ERCP （endoscopic retrograde cholangiaopancreatography）. [Methods] Patients underwent ERCP to precisely understand the location, degree and extent of the pancreaticobiliary duct obstruction. Then the stents were placed into biliary and pancreatic ducts though the guidewires. After the operation, the level of serum amylase, clinical symptoms such as jaundice, abdominal pain, diarrhea and prolongation of ductal patency were observed to assess the therapeutic effect. [Results] The total effective rate was 89.3%. The effective rate in the middle and distal bile duct was 90.9%, and the hilar part was 84.8%. Among 6 abdominalpain patients, the symptom disappeared in 2 patients and significantly decreased in 2 patients two weeks after the operation. Among 3 diarrhea patients, the symptom disappeared in 1 patient and significantly decreased in 1 patient with in 1 month. 6 patients suffered from postoperative hyperamylasemia. The incidence rate was 21.4%. All of them returned to normal with in 72 h. Postoperative cholangitis took place in 7.1% of patients within 2 weeks. The stents were Unobstructed for a mean duration of 7 months. There were no severe operation related complications and mortality. [Conclusions] The therapy with implanting multiple stents for relieving benign or malignant biliary pancreatic obstruction is safe and effective. It can relieve jaundice and abdominal pain quickly, decrease biliary pressure and improvt. the exocrine dysfunction of pancreas.