恶性胆总管梗阻合并胃出口一十二指肠梗阻的内镜治疗价值分析

Value analysis of endoscopic management of malignant obstruction combined common bile duct and gastric outlet-duodenum obstruction

目的探讨经内镜置入胆管及肠道支架联合治疗胆总管恶性梗阻合并胃出口．十二指肠梗阻的临床价值。方法对17例同时存在胆管及胃出15一十二指肠梗阻的恶性肿瘤患者在完成胆管金属支架置入术后再行肠道金属支架置入。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17例患者经内镜下置入胆管支架和肠道支架，成功率100％；术后7天患者血清总胆红素[（263．4±62．5）μmol／L降至（157．6±25．1）μmol／L]、直接胆红素[（233．2＋66．5）μmol／L降至（130．9±27．7）μmol／L]和碱性磷酸酶[（534．2＋78．7）IU／L降至（216．3±23．3）IU／L]均明显下降（P〈0．01），胃出口梗阻评分[（0．9＋1．1）分升至（2．1±0．7）分]明显上升（P〈0．01）。所有患者均未出现严重并发症，生存70～332d，中位生存时间192d。结论联合双支架置人是治疗胆管合并胃出口一十二指肠恶性梗阻的安全有效的方法。

Objective To evaluate curative effects of treatment of malignant biliary and gastric out-let-duodenal obstruction with endoscopicaUy placed self-expandahle metal stents. Methods A retrospective analysis was performed in 17 patients who underwent enteral 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 17 patients, biliary stenting were all performed for obstructive jaundice and then enteral stents were inserted. The levels of tatal billiru-bin [from （263.4 ± 62.5 ） p, moL/L to （ 157.6 ± 25.1 ） μmol/L], direct billirubin [ from （ 1233.2 ± 66.5） μmol/L to （ 130.9 ± 27.7 ） μmol/L ] and alkaline phosphatase [ from （ 233.2 ± 66. 5 ） IU/L to （130. 9 ±27.7）IU/L] decreased significantly （P 〈 0. 01 ）, and the gastric outlet score increased signifi- cantly [ from （0. 9 ± 1.1 ） points to （2. 1 ± 0. 7 ） points ] （P 〈 0. 01 ）. No serious complication in all pa-tients. Lifetime of patients ranged from 70 days to 332 days, and the median survival time was 192 day. Conclusion Combined biliary and enteral stenting is an effective method for palliation of malignant biliary and gastric outlet-duodenal obstruction.