胰腺癌合并胃出口及胆管梗阻的内镜治疗及疗效

Endoscopic treatment for pancreatic cancer patients with biliary obstruction and gastric outlet obstruction

目的探讨胰腺癌伴胃出13及胆管梗阻的内镜治疗策略及疗效。方法回顾性分析2010年1月至2013年12月沈阳军区总医院收治的106例晚期胰腺癌伴胃出口及胆管梗阻患者的一般临床资料、内镜治疗方法、术后并发症及疗效。结果106例患者中男性57例，女性49例，平均年龄（63±6）岁。共行134次内镜治疗，平均1．3次／人。共放置肠道支架112枚，胆管支架89枚，胰管支架55枚，其中肠道支架均为一次性放置成功。胆管、胰管及肠道3种支架同时放置者55例（51．9％），胆管、肠道双支架同时放置23例（21．7％），28例（26．4％）因内镜无法通过狭窄段而先放置肠道支架，再经肠道支架完成胆管支架置入。83例（78．3％）患者于支架置人术后9—14d恢复正常饮食。术后并发黑便9例，高淀粉酶血症6例，呕血1例，均经对症治疗后治愈；1例术后第3天支架经肛门排出。83例获得24周随访，死亡49例（59．0％），平均生存期（128±33）d。随访期发生肠道支架堵塞6例，4例放置第2枚肠道支架，2例取出肠道支架后重新放置。结论多支架治疗胰腺癌伴胃出口及胆管梗阻是安全的，并发症发生率低，近期疗效确切，并能明显改善患者的生活质量。

Objective To investigate the endoscopic treatment strategy and efficacy for pancreatic cancer patients with biliary obstruction and gastric outlet obstruction. Methods Retrospective review was performed between January 2010 and December 2013 on 106 pancreatic cancer patients with biliary obstruction and gastric outlet obstruction who were admitted to General Hospital of Shenyang Military Region. All patients underwent palliative endoscopic treatment. The clinical data, method of therapeutic endoscopy, complication rate and efficacy were evaluated. Results Of the 106 patients, 57 were male and 49 were female, and the mean age was （63 ~ 6） years old. One hundred and thirty-four endoscopic procedures were performed, with an average of 1.3 procedures per person. A total of 112 duodenal stents was placed with one session success rate 100%, 78 biliary stents and 55 pancreatic duct stents were also inserted. All 3 stents were simultaneously placed in 55 cases （51.9%）, and both of duodenal stents and biliary stents were simultaneously placed in 23 cases （21.7%）. For 28（26.4% ） patients who had gastric outlet obstruction, duodenal stents were placed first, and then biliary stents were inserted through duodenal stents. Eighty-three cases （ 78.3% ） resumed normal diet 9 - 14 d after stents placement. Complications included melena in 8 cases, hyperamylasemia in 6, hematemesis in 1, and all of them recovered with conservation management. One stent migrated through anus at the 3rd day after endoscopic procedure. Eighty-three patients were followed up for 24 weeks, and 49 patientsdied （59.0%） , the average survival time was （128 ± 33 ）d. During follow-up, stent obstruction was observed in 6 patients, and 4 patients received the second duodenal stent, while 2 patients underwent re-stenting after extraction of the original duodenal stent. Conclusions Multiple stents＇ treatment for pancreatic cancer patients with biliary obstruction and gastric outlet obstruction is safe with low complication rate and remarkable short- term efficacy, and it can significantly improve the patients＇ quality of life.