经内镜置入胆管支架和十二指肠支架联合治疗胰腺癌的临床应用

Clinical application of combined endoscopic biliary and duodenal stenting for palliation of pancreatic cancer

目的探讨经内镜置入胆管及十二指肠支架联合治疗胰腺癌的临床价值。方法对14例同时存在胆管及十二指肠梗阻的胰腺癌患者在完成胆管支架置入术后再行十二指肠支架置入。观察操作成功率、胆管及消化道梗阻缓解情况、并发症发生情况、支架再阻塞情况以及患者生存期。结果其中12例经口置入双支架,1例置入胆管支架后经胃造瘘口置入十二指肠支架,成功率92.86%,以上13例患者术后胆管及消化道梗阻情况均获缓解,1例十二指肠支架置入失败;14例患者均未出现严重并发症,其中1例术中少量出血,2例出现一过性高淀粉酶血症,并发症发生率为21.43%;2例出现十二指肠支架再梗阻;中位生存时间195d。结论联合双支架置入是治疗胆管及十二指肠恶性梗阻的安全有效的方法。

[Objective] To evaluate curative effect of combined biliary and duodenal stenting in the palliation of pancreatic cancer.[Methods] A retrospective analysis of patients who underwent duodenal stenting after placement of the biliary stent.The success rate of insertion,the effective palliation of biliary and duodenal obstruction,the rate of complication,recurrent stent obstruction and the median patency were observed.[Results] In 14 patients,biliary stenting were performed for obstructive jaundice and then duodenal stents were inserted（12 through mouth,1 through gastic fistula） in 13 patients,one procedure failed during duodenal stenting.No serious complication in all patients,a few bleeding during procedure occured on one patient and transient hyperamylasemia after procedure occured on two patients,the rate of complication was 21.43%;two patients had recurrent obstruction of duodenal stents;the median survival time was 195 day.[Conclusions] Combined biliary and duodenal stenting is an effective method for palliation of malignant biliary and duodenal obstructions.