内镜下双支架治疗胆管癌合并十二指肠梗阻的远期效果及其影响因素

Long-term Effect of Endoscopic Double Stents in the Treatment of Cholangiocarcinoma with Duodenal Obstruction and Its Influencing Factors

目的 探究内镜下双支架治疗胆管癌合并十二指肠梗阻的远期效果及其影响因素。方法 选择胆管癌合并十二指肠梗阻患者60例,均行十二指肠支架及胆道支架内镜下置入治疗。对患者进行3年随访,观察患者远期效果,分析影响患者预后的相关因素。结果 3年随访,平均随访时间为(1.63±0.61)年。随访期间5例术后出现轻症胰腺炎,发生率为8.33%;6例患者因十二指肠支架置入造成肿瘤于支架内生长导致堵塞,发生率为10.00%;28例患者因胆管支架置入出现胆管支架阻塞后再发黄疸等症状,发生率为46.67%。3年随访中死亡18例,生存42例;死亡组淋巴结转移、Ⅲ型病理分型、低分化肿瘤分化程度发生率均高于生存组,差异有统计学意义(P<0.05);淋巴结转移、病理分型、肿瘤分化程度是影响内镜下双支架治疗胆管癌合并十二指肠梗阻患者预后的独立危险因素(OR值≥1,且P<0.05)。结论 内镜下双支架可有效治疗胆管癌合并十二指肠梗阻,能够缓解病情,改善患者生存质量,延长生存时间。淋巴结转移、病理分型、肿瘤分化程度是影响患者预后的重要因素,在治疗中可联合其他辅助方式干预,以改善病情。

Objective To explore the long-term effect and influencing factors of endoscopic double stents in the treatment of cholangiocarcinoma with duodenal obstruction.Methods 60 patients with duodenal obstruction were treated with duodenal stent and biliary stent.Patients were followed up for 3 years to observe the long-term effects and other factors affecting patient prognosis.Results 3-year follow-up,the mean follow-up time was(1.63±0.61) years.During the follow-up period,5 cases developed mild postoperative pancreatitis,with an incidence of 8.33%;Six patients were blocked due to stent growth in duodenal stent,The incidence rate was 10.00%;In 28 patients,jaundice appeared after bile duct stent obstruction because of bile duct stent implantation,The incidence rate was 46.67%;During the 3-year follow-up,18 patients died and 42 survived;The incidence of lymph node metastasis,type Ⅲ pathological classification and differentiation degree of poorly differentiated tumors in the death group were higher than those in the survival group,Differences were statistically significant(P<0.05);Lymph node metastasis,pathological typing,and degree of tumor differentiation are independent risk factors influencing the prognosis of patients with endoscopic bistent treatment of cholangiocarcinoma combined with duodenal obstruction(OR ≥ 1,AndP<0.05).Conclusion Endoscopic double stent can effectively treat cholangiocarcinoma with duodenal obstruction,improve quality of survival,and prolong survival time;lymph node metastasis,pathological classification and tumor differentiation are important factors affecting patient prognosis,which can be combined with other auxiliary methods to improve the condition.