内镜下肠道金属支架治疗胰头十二指肠切除术后恶性输入袢梗阻的疗效评价

Evaluation of endoscopic metal stent implantation for afferent limb obstruction after pancreaticoduo-denectomy

目的评价内镜下肠道金属支架置入术治疗胰头十二指肠切除术（PD）术后恶性输入袢梗阻的临床价值。方法2010年1月至2014年12月间，5例行内镜下肠道金属支架置入术治疗的PD术后恶性输入袢梗阻患者纳入回顾性分析，总结内镜手术操作完成情况、并发症发生情况及治疗效果等。结果5例均一次性成功置入支架，术后腹胀及胆管炎表现均明显缓解，3～5d肝功能均明显好转，未出现明显的上腹部不适，无出血、穿孔、支架移位等并发症发生。术后3个月复查CT均提示支架扩张良好。术后生存时间3～8个月，平均4．6个月，均未发生输入袢再次梗阻。结论内镜肠道金属支架置入术治疗PD术后恶性输入袢梗阻安全有效，可明显缓解患者症状、提高患者生活质量。

Objective To evaluate the efficacy of endoscopic metal stent implantation for afferent limb obstruction after pancreaticoduodenectomy （PD）. Methods A retrospective analysis of 5 patients with afferent limb obstruction after PD treated by endoscopic metal stent implantation was performed.Data of each patient was reviewed including the records of the endoscopic procedure, the complications and the clinical outcomes. Results All the metal stents were implanted successfully in the 5 patients. The abdominal disten- sion and cholangeitis were well relieved in all the patients. The liver function improved in all the patients in 3 to 5 days.No abdominal discomfort, bleeding, perforation, or stent dislocation occurred. CT scan showed that all stents were well expanded.The survival time of the 5 patients were 3 to 8 months, and 4. 6 months on av- erage. There was no recurrence of afferent limb obstruction. Conclusion For afferent limb obstruction after PD, endoscopic metal stent implantation is effective in relieving obstruction, the symptoms, and improving the quality of life.