内镜下同期放置双侧金属胆道支架治疗肝门部胆管恶性梗阻疗效观察

Efficacy of Endoscopic Bilateral Biliary Metal Stent Placement for Malignant Hilar Biliary Obstruction

目的探讨经内镜同期置入双侧可膨式金属胆道支架治疗肝门部胆管恶性梗阻的安全性与有效性。方法收集2007年5月至2010年12月期间因肝门部胆管恶性梗阻而接受内镜下同期双侧金属支架置入患者,记录技术成功率、引流有效率、随访ERCP相关性并发症、支架通畅期与生存期。结果共有24例肝门部胆管恶性梗阻患者接受内镜下同期双侧金属支架置入,完成随访21例,平均随访时间39个月。技术成功率为100%,平均耗时（36.2±13.9）min,引流有效率为95.45%（21/22）。ERCP后发生胆管炎2例,无胰腺炎、消化道出血、穿孔及ERCP相关性死亡病例。7例患者随访期内支架失效,其中4例患者再次置入塑料支架,1例行PTCD后症状缓解,其余2例行保守治疗。支架中位通畅期为253 d（95%CI：199.79~306.21）,BismuthⅡ、Ⅲ、Ⅳ型间通畅期差异无统计学意义（P=0.576）;中位生存期为229 d（95%CI：154.53~303.47）,BismuthⅡ、Ⅲ、Ⅳ型间生存期差异无统计学意义（P=0.748）。结论经内镜同期置入双侧金属支架治疗肝门部胆管恶性梗阻是可行、安全和有效的。

Objective To evaluate the safety and efficacy of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents in malignant hilar biliary obstruction.Method From May 2007 to December 2010,a total of 24 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ underwent endoscopic retrograde cholangiopancreatography（ERCP） and bilateral metal stent placement.Technical success rate,functional success rate,ERCP related complications,stents＇ patency time,and patient＇ survival time were recorded and reviewed.Results Twenty-one of 24 patients were followed-up for average 39 months.Technical success rate was 100%,the average operation time was（36.2±13.9） min,the functional success rate was 95.45%.Mild cholangitis occurred in 2 cases and there was no ERCP related pancreatitis,bleeding,perforation,and death.Stents dysfunction occurred in 7 within follow-up period.Amonge them,plastic stents were inserted through the metallic stents in 4 cases,PTCD was required in 1 case,and conservative therapy was given in the other 2 cases.The median stent＇ patency time and median patient＇ survival time were 253 d（95% CI： 199.79-306.21） and 229（95% CI ： 154.53-303.47）,respectively,with no significant differences between Bismuth classification types.Conclusion Endoscopic simultaneous bilateral biliary metal stent placement is technically feasible,safe,and effective to malignant hilar obstruction.