| 摘要: |
| 目的 探讨恶性胆、肠梗阻患者内镜下同期实施胆、肠双自膨胀金属支架(self-expanding metallic stent,SEMS)治疗的策略、方法及其安全性和有效性。 方法 回顾性分析2009年1月至2012年6月我院收治的阻塞性黄疸合并十二指肠恶性狭窄行内镜下同期置放胆、肠双SEMS患者的临床资料,分析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(GOOSS) 评分情况。结果 共收治10例同期放置胆、肠双SEMS的患者,包括胰腺癌5例、胆囊癌2例、胆管癌2例及十二指肠乳头癌1例。5例Ⅰ型肠狭窄(病变未侵及十二指肠乳头)患者置入肠道SEMS后再行内镜逆行胆胰管造影(ERCP)成功放置胆道SEMS。另1例Ⅰ型肠狭窄患者放置长度9 cm的肠道SEMS后，再行超声内镜下顺行胆胰管造影（EACP），经超声内镜引导下胆管引流（EUS-BD）放置胆道SEMS； 3例Ⅱ型狭窄（病变侵及十二指肠乳头）患者行EACP，经EUS-BD放置胆道SEMS后，再经内镜置入肠道SEMS。1例Ⅲ型肠狭窄(远离十二指肠乳头)患者分别置入胆、肠SEMS。内镜操作成功率为100%。内镜操作术中2例Ⅰ型肠狭窄患者在内镜通过肠狭窄段时有肠壁自限性出血,未发生持续出血或穿孔等与内镜操作相关的并发症。黄疸消退及GOOSS评分改善明显。结论 对于胆道梗阻合并十二指肠狭窄不能手术切除患者,结合不同的内镜处理方式同期置入胆、肠双SEMS姑息性解除胆、肠梗阻是可行且安全、有效的。 |
| 关键词: 内镜逆行胆胰管造影术 腔内超声检查 顺行胆胰管造影术；引流术；胆道恶性梗阻 十二指肠恶性梗阻 |
| DOI：10.3724/SP.J.1008.2013.00261 |
| 投稿时间：2012-10-19修订日期：2012-11-15 |
| 基金项目: |
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| Simultaneous stenting in bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction |
| PAN Ya-min,WANG Tian-tian,GAO Dao-jian,WU Jun,HU Bing* |
(Department of Endoscopy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
*Corresponding author.) |
| Abstract: |
| Objective To investigate the therapeutic strategies, methods, safety and efficacy of simultaneous placement of self-expanding metallic stent (SEMS) in the bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction. Methods The clinical data of patients with obstructive jaundice combined with severe duodenal stricture, who were treated with simultaneous placement of biliary SEMS and duodental SEMS under endoscope during January 2009 to June 2012, were retrospectively analyzed. The success rate of endoscopic management, complications, relief of jaundice and results of gastric outlet obstruction scoring system (GOOSS) were analyzed. Results Totally ten patients meeting the criteria were analyzed in this study. The patients included 5 cases with pancreatic cancer, 2 with gallbladder cancer, 2 with cancer of bile duct and one with duodenal papilla caner. Five patients with type Ⅰ duodenal stricture (without invading duodenal papilla) successfully received biliary stents through endoscopic retrograde cholangiopancreatography (ERCP) after placement of duodenal stents. One patient with type Ⅰ duodenal stricture was implanted with a 9 cm duodenal stent before endoscopic anterograde cholangiopancreatography (EACP), then a SEMS was implanted in the bile duct through endoscopic ultrasonography-guided biliary drainage (EUS-BD). Three patients with type Ⅱ duodenal stricture (with invading duodenal papilla) underwent EACP and biliary stent placement through EUS-BD, and then the duodenal stent was deployed in duodenum after EACP. The patient with type Ⅲ (away from the duodenal papilla) was implanted with biliary and duodenal stents. The success rate of endoscopic management was 100%. Two patients had self-controlled bleeding of intestinal mucosa, which was caused by endoscope friction when passing through the duodenal stricture, but without any continuous bleeding or perforation. Symptoms of jaundice and gastric outlet obstruction were greatly relieved after treatment. Conclusion For patients with unresectable malignant biliary obstruction combined with duodenal stricture, endoscopic placement of SEMS in the bile duct and duodenum simultaneously is a safe and effective method to palliate dual malignant obstruction via different endoscopic managements. |
| Key words: endoscopic retrograde cholangiopancreatography endosonography anterograde cholangiopancreatography drainage malignant biliary obstruction malignant duodenal obstruction |
