【摘要】 目的探讨胆道支架、十二指肠支架置入治疗胆道合并十二指肠恶性梗阻的临床价值。方法 2008年1月~2013年12月,对24例同时存在胆道和十二指肠恶性梗阻的患者完成胆道支架、十二指肠支架置入,其中介入中心10例患者行经皮肝穿刺造影完成胆道金属支架置入(percutaneous transhepatic insertion of biliary stent,PTIBS),14例消化内镜中心患者行逆行胰胆管造影放置胆道金属支架(endoscopic retrograde cholangiopancreatography-guided biliary stent,ERCP-BS),其中1例失败后改行经皮肝穿刺胆管外引流术不纳入随访研究。胆管支架置入术后1周完成十二指肠支架置入。观察手术成功率、临床症状缓解率、并发症、支架通畅时间及患者生存期等指标。结果联合支架置入成功率95.8%(23/24),梗阻症状消失率87.0%(20/23);十二指肠支架置入术后1周胃出口梗阻评分(2分6例,3分17例)较术前(0分6例,1分17例)明显改善(Z=-4.796,P=0.000)。胆道支架通畅时间(73.9±5.3)d,生存时间(93.0±4.9)d。十二指肠支架再发梗阻率17.4%(4/23)。均未出现严重并发症。结论胆道、十二指肠支架联合置入治疗恶性胆道、十二指肠梗阻安全有效。更多还原

【Abstract】 Objective To evaluate curative effects of combined biliary and duodenal stent placement for malignant biliary and duodenal obstruction. Methods A total of 24 patients who underwent biliary and duodenal stent placement due to inoperable malignant biliary and duodenal obstruction were analyzed retrospectively, 14 of whom underwent endoscopic retrograde cholangiopancreatography-guided biliary stent( ERCP-BS) and 10 underwent percutaneous transhepatic insertion of biliary stent( PTIBS). Duodenal stent was placed one week after biliary stent insertion. In the ERCP-BS group,1 case was given a second percutaneous transhepatic biliary drainage after the failure of ERCP-BS,and was excluded in the follow-up study. The success rate of the procedure,rate of symptom relief,complications,stent patency,and overall survival were evaluated. Results The success rate of combined stent placement was 95. 8%( 23 /24),and the clinical remission rate was 87. 0%( 20 /23). According to the Gastric Outlet Obstruction Scoring System,the scores at 1 week after stent placement( 2 points in 6 cases and 3 points in 17 cases) were significantly improved as compared with preoperation( zero in 6 cases and 1 point in 17 cases,Z =- 4. 796,P = 0. 000). The patent period of biliary stent was( 73. 9 ± 5. 3) days,and the survival time from combined stenting was( 93. 0 ± 4. 9) days. The rate of reobstruction of duodenal stent was 17. 4%( 4 /23). No severe complications was found. Conclusion Combined biliary and duodenal stent placement is safe and effective in the treatment of malignant biliary and duodenal obstruction.更多还原