经内镜置入胆道及十二指肠自膨式金属支架治疗恶性梗阻性黄疸并十二指肠梗阻

Clinical Effectiveness of Combined Biliary and Duodenal Endoscopic Stent Implanted for Malignant Obstructive Jaundice and Duodenal Obstruction

目的探讨经内镜置入胆道及十二指肠自膨式金属支架(self-expandable metal stents,SEMS)治疗恶性梗阻性黄疸合并十二指肠梗阻的临床疗效及技术难点。方法对于2014-01/2015-12月作者医院经内镜下置入胆道及十二指肠SEMS的21例恶性梗阻性黄疸并十二指肠梗阻患者的临床资料进行回顾性分析,观察内镜操作的成功率及并发症、术后黄疸消退及胃流出道梗阻评分系统(gastric outlet obstruction scoring system,GOOSS)评分情况。结果 18例经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)成功置入胆道金属支架,成功率85.71%;3例经ERCP置入支架失败者,行经皮肝胆道穿刺置管引流术(percutaneous transhepatic cholangial drainage,PTCD)成功解除梗阻性黄疸;21例十二指肠支架均成功经内镜置入,成功率100%;18例患者胆道金属支架置入术后血清胆红素均明显下降(>30%),血清总胆红素水平由术前的平均(305.89±88.61)μmol/L,下降至(41.59±26.20)μmol/L,(t=17.209,P=0.000);十二指肠支架置入术后18例能进普食或半流食,3例能进流食,术前GOOSS评分为(0.57±0.51)分,术后1周为(2.19±0.67)分(t=6.642,P=0.000)。结论对于无法手术的恶性梗阻性黄疸合并十二指肠梗阻患者,经内镜置入胆道及十二指肠金属支架是一种安全、有效的姑息治疗方法。

Objective To explore the method of implanting biliary and duodenum self-expandable metal stents（SEMS）by endoscopy,and to evaluate the effect of SEMS on palliation of malignant biliary obstruction associated with duodenal obstruction.Methods The clinical data from21 cases of malignant biliary and duodenal obstruction by endoscopy implanted biliary and duodenal SEMS from January 2014 to December 2015 were analyzed retrospectively.The success rate of endoscopic management,complication,relief of jaundice and gastric outlet obstruction scoring system score（GOOSS）were analyzed.Results Eighteen cases implanted biliary SEMS by endoscopic retrograde cholangiopancreatography（ERCP）,which had success rate of 85.71%.Another 3 cases who implanted unsuccessfully were alleviated biliary obstruction by percutaneous transhepatic cholangial drainage（PTCD）.All 21 cases implanted duodenum SEMS by endoscopy,which had success rate of 100%.The serum total bilirubin of 18 cases implanted biliary SEMS significantly decreased from（305.89±88.61）μmol/L to（41.59±26.20）μmol/L（t=17.209,P=0.000）.Eighteen cases implanted duodenum SEMS were able to take solid food or semi-liquid food,the other 3 cases were able to take liquid food.The GOOSS scores of 21 patients increased significantly from（0.57±0.51）to（2.19±0.67）after treatment 1 week（t=6.642,P=0.000）.Conclusion The implantation biliary and duodenum SEMS via endoscopy for patients with malignant biliary obstruction associated with duodenal obstruction is a simple and effective palliative treatment.