金属内支架在恶性胆道梗阻合并十二指肠梗阻治疗中的应用价值

Application of metallic stents for palliative treatment of malignant biliary and duodenal obstruction

目的探讨经内镜下逆行胰胆管造影(ERCP)与经皮肝穿刺置入胆道支架,后经口置入十二指肠支架的方法,评价金属支架在治疗恶性胆道合并十二指肠梗阻的作用。方法恶性梗阻性黄疸合并十二指肠梗阻病例16例经ERCP方法先置入胆道金属支架11例,经皮肝穿刺置入胆道金属支架4例,后经口置入16个十二指肠金属支架,单纯置入胆道外引流1例。结果 14例患者一次同时成功放置胆道和十二指肠金属支架,其中4例胆道支架是经皮肝胆管造影(PTC)方法置入,1例放置胆道支架后2个月因十二指肠梗阻,再置入十二指肠金属支架。1例导丝不能通过胆道阻塞段,仅放置胆道外引流管。随访期间,除1例仅能进流质外其余患者能正常饮食或进半流质,黄疸基本消退,疗效满意,无严重的并发症发生。结论运用内镜或介入置入金属内支架是一种简单、有效的治疗方法,对不能手术治疗的恶性梗阻性黄疸合并十二指肠梗阻有很好的缓解作用。

【Objective】To explore the methods of implanting biliary metallic stent via endoscopic retrograde cholangiopancreatography （ERCP） or percutaneous transhepatic cholangiography （PTC）,then implanting duodenal stent,to evaluate the efficacy of palliative treatment of malignant biliary and duodenal obstruction with metallic stents. 【Methods】Of the 16 patients with malignant biliary and duodenal obstruction,11 biliary metallic stents were implanted by ERCP,4 biliary metallic stents were implanted by PTC,16 duodenal metallic stents were implanted through the mouth,1 outer draining was done. 【Results】14 patients were performed simultaneously in biliary and duodenal stents and 4 patients biliary stents were implanted by PTC,in another patient duodenal stent was placed after biliary stenting when duodenal obstruction symptoms had developed two months later. The outer biliary draining was performed in 1 patient because the guidewire could not advance through the obstruction. During follow-up,all patients except one were able to take semi-liquid or solid food,the jaundice was alleviated,and the result was satisfactory,no major complication occurred in all cases.【Conclusion】The implantation of metallic stent by endoscopic and interventional procedure is a simple and effective method which may provide a palliative treatment of malignant biliary and duodenal obstruction for patients who are poor candidates for surgery.