内镜下双支架治疗晚期胰头恶性肿瘤患者胆肠梗阻的探讨

Endoscopic placement of double stents in treatment of jaundice and enteral obstruction in patients with advanced pancreatic cancer

目的探讨解决晚期胰头恶性肿瘤患者的胆道梗阻和肠道梗阻的内镜治疗方法。方法对晚期胰头恶性肿瘤患者采用内镜逆行胰胆管造影放置胆道支架治疗胆道梗阻,于内镜下放置肠道支架治疗肠道梗阻。结果共诊治11例患者,放置胆道支架1个月后肝功能基本恢复至正常水平,血清总胆红素、直接胆红素水平分别为(27.1±10.5)、(12.8±5.3)μmol/L,均较术前的(200.2±115.2)、(139.7±72.7)μmol/L显著下降(P值均<0.05)。肠道支架放置后,患者可进食半流质甚至普食。本组无1例发生严重并发症。随访时间为5～18个月,缓和中位生存期为9个月。放置双支架后2周,对11例患者的生活质量进行评估,Karnofsky评分平均为(72.7±9.0)分。结论晚期胰头恶性肿瘤患者放置胆道支架和肠道支架治疗后,可明显改善临床症状,并可有效地提高此类晚期癌症患者的生活质量。

Objective To explore an endoscopic method for treatment of jaundice and enteral obstruction caused by advanced pancreatic cancer.Methods Placement of biliary stent was used to treat obstruction in bile duct by endoscopic retrograde cholangiopancreatography（ERCP）,and the enteral stent was placed a few months later when there was duodenum obstruction.Results A total of 11 patients were treated;their bilirubin level decreased quickly to almost the normal level one month later,with the mean serum total bilirubin and direct bilirubin being（27.1±10.5） and（12.8±5.3）μmol/L,respectively,which were significantly lower than those before operation（[200.2±115.2],[139.7±72.7]μmol/L,p0.05）.The patient could have semifluid or ordinary food after placement of enteral stent.No severe complications were found.The patients were followed up for 5- 18 months,with the median survival time being 9 months.The average Karnofsky score was（72.7±9.0） for the patients two weeks after placement of biliary and enteral stents.Conclusions Placement of biliary stent and enteral stent can greatly improve the clinical symptoms of advanced pancreatic cancer patients,and can effective upgrade the life quality of patients with advanced pancreatic cancer.