经皮穿肝经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻

目的:探讨胆管和十二指肠恶性梗阻双途径联合支架置入介入治疗的方法和效果.方法:23 例胆管和十二指肠恶性梗阻,17例先经皮肝穿刺置入金属支架解除胆管梗阻,出现十二指肠梗阻后,再在X线透视下,经口腔置入记忆合金网状十二指肠内支架.6例因胆管与十二指肠恶性梗阻并存,先置入十二指肠内支架并同时置入胆管支架.测定术前、术后血清总胆红素水平及体重并进行t检验.结果:23例患者双途径联合支架置入成功后,术前、术后血清总胆红素水平及体重比较差异均有显著性意义(P＜0.05).十二指肠支架置入后,消化道梗阻症状迅即解除,当日即能进食,均无严重并发症发生.随访1～20个月进食情况均良好.结论:经皮肝穿经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻是首选的有效治疗方法.     

金属支架置入结合动脉灌注化疗治疗胃、十二指肠恶性梗阻

目的 探讨金属支架置入结合动脉灌注化疗对胃、十二指肠恶性梗阻的疗效.方法 32例胃、十二指肠恶性狭窄患者,梗阻部位位于胃窦及幽门部16例、胃肠吻合口6例、十二指肠降段10例,均在DSA下或结合胃镜经口腔先将导丝放置于胃幽门部及十二指肠梗阻部位,然后置入镍钛合金网状支架于狭窄部位,其中16例术后给予肿瘤供血动脉灌注化疗....     

经口支架置入术治疗胃十二指肠恶性梗阻

目的 探讨经口释放支架治疗胃十二指肠恶性狭窄的治疗方法及临床疗效.方法 12例胃十二指肠恶性梗阻患者,梗阻部位位于胃窦及幽门部4例,胃肠吻合口3例,位于十二指肠降段及以远5例,均在X线引导下采用介入放射学方法,经口腔置入记忆合金支架12枚,并观察术后临床疗效.结果 12例患者均一次性置入支架成功,未出现并发症及不良反应,术后梗阻情况均解除,术后2月,支架均保持通畅,随访结果显示患者死前均未再次出现消化道梗阻症状.结论 金属支架置入术具有操作安全简便、创伤小、恢复快、并发症少等特点,是无法手术治疗的胃十二指肠恶性梗阻有效的治疗方法.     

金属内支架置入术治疗胃十二指肠恶性梗阻

目的　探讨不能手术的胃十二指肠恶性梗阻金属内支架治疗方法和效果。方法　 67例胃十二指肠恶性梗阻 ,胃窦及幽门部梗阻 2 7例 ,十二指肠降段及以远梗阻 2 6例 ,胃十二指肠及胃空肠吻合口梗阻 14例 ,均在X线透视下采用介入放射学方法 ,经口腔共置入记忆合金网状内支架 84枚 ,其中 17例因支架置入 6个月后再梗阻又放置了第 2枚支架。结果　 67例患者支架置入成功后 ,梗阻症状迅速解除 ,当日即能进食。术后 1个月与术前比较 ,体重平均增加 4.7kg ,无严重并发症发生。随访 1～ 2 0个月均进食情况良好。结论　金属内支架置入术操作简单、微创、可重复 ,是无法手术治疗的胃十二指肠恶性梗阻首选有效的治疗方法。     

经皮肝途径联合置入胆道和十二指肠支架

作者报道了胆总管合并十二指肠恶性梗阻2例。例1,诊断为腹膜后平滑肌肉瘤,致十二指肠梗阻。先前曾作了胃空肠吻合术。经皮肝穿胆管造影示:胆总管中度扩张并十二指肠第二、三段狭窄及变形。例2,为直肠癌转移致十二指肠梗阻;造影示:肝总管和总胆管狭窄,及十二指肠第三段的狭窄。两者均失去手术根治机会,由于十二指肠受累,导致ERCP和内镜置入支架失败,而选经皮肝穿途径同时置入十二指肠和胆管内支架,缓解两处梗阻。     

胃十二指肠恶性梗阻内支架治疗12例报告

目的 用金属内支架缓解不能手术的胃十二指肠恶性梗阻患者的症状。资料与方法 12例胃十二指肠恶性梗阻患者均有反复恶心呕吐症状，且不能手术治疗。在透视监视下，使用介入放射学方法置入13个自膨胀式金属内支架。结果 12例患者支架置入均成功，随访期间患者均能进食，呕吐减轻，生活质量提高。无严重并发症发生。结论 金属内支架置人是一种简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

Separate支架在治疗胃十二指肠恶性梗阻中的应用

目的 探讨Separate支架置入术在姑息性治疗不能手术的胃肠道恶性梗阻的可行性和有效性。方法 34例患者采用经口置入Separate支架治疗不能手术的恶性胃十二指肠梗阻。梗阻的原因分别是胃癌11例、胰腺癌12例、转移性肿瘤3例、胆道肿瘤6例和十二指肠癌2例。透视下分别将Separate支架的外层带膜支架和内层裸支架同轴重叠释放在狭窄病变处。结果 技术成功率为97％，未发生严重并发症。33例患者胃肠道梗阻症状缓解或消失，在Separate支架置入后，患者进食能力评分平均从3．8提高到1．2。随访期间未发现支架移位和肿瘤内生性生长等并发症，l例患者由于肿瘤浸润致支架近端梗阻复发，置入第2枚支架。结论 经口途径置入Separate支架姑息性治疗不能手术的胃十二指肠恶性梗阻是可行的和有效的。     

X线引导下金属支架置入治疗胃十二指肠恶性梗阻32例临床随访研究

目的 探讨X线引导下金属支架置入术治疗胃十二指肠恶性梗阻的临床随访与评价.方法 选取32例胃十二指肠恶性梗阻患者,行X线监视下进入导管导丝,超过狭窄或梗阻段,交换人软头超硬导丝,经超硬导丝置入并释放自膨式金属肠道支架.结果 28例患者成功置入支架,成功率为88％.术中透视造影示支架均定位准确、通畅.27例支架放置后1周内梗阻症状得到缓解或消除,临床有效率为96％.7例术后1个月左右出现梗阻复发,3例予再次放置第2枚支架后缓解.患者术后1个月生存率96％,术后2月生存率61％,术后6个月生存率25％.1例患者目前仍在随访中.结论 X线下金属支架置入治疗胃十二指肠恶性梗阻是一种可行、安全有效的方法.     

胃十二指肠良恶性狭窄的内支架治疗

目的探讨金属内支架在治疗不能手术的胃十二指肠交界处良恶性梗阻中的作用、疗效和并发症。方法１１例病人，８例术后吻合口复发狭窄，１例胃幽门良性狭窄，２例恶性狭窄。在透视监视下，使用介入放射学方法置入１１个自膨胀式金属内支架。结果１１例病人支架置入均成功，１０例梗阻症状立即解除，随访期间病人均能进食，疗效满意。本组无严重并发症发生。结论介入放射学置入金属内支架是一个简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

自膨式覆膜支架在食管、十二指肠恶性狭窄及瘘的临床应用

目的 评价食管、十二指肠恶性狭窄及瘘应用自膨式覆膜支架治疗的价值,探讨支架植入后常见的并发症及处理方法 .方法 87例上消化道狭窄或梗阻患者中,50例食管恶性狭窄,23例贲门-胃吻合口狭窄,5例胃、十二指肠恶性狭窄,3例食管瘘,6例食管吻合口瘘,共置入国产带膜网状支架95枚.结果 内支架置入全部一次成功,除1例患者术中急性出血外,余病例无即刻并发症,术后患者狭窄解除,饮食得到恢复,瘘道封闭,远期疗效与疾病性质和相关治疗情况有关.结论 自膨式覆膜支架治疗食管、十二指肠恶性狭窄及瘘疗效可靠,并发症少,术后加放疗和(或)化疗可进一步提高疗效.     

胆肠双支架对胰头癌的姑息性治疗效果初探

目的探讨胆道内支架和十二指肠金属内支架联合应用治疗胰头癌的价值。方法2003年8月～2005年7月，对4例出现胆道梗阻的胰头癌患者先置入胆道内支架行减黄治疗，当其出现上消化道梗阻症状时，再置入十二指肠金属内支架，观察该治疗方法的疗效。结果4例患者的胆道和十二指肠内支架均一次置放成功。置入胆道内支架后，所有患者的胆红素水平在24h后下降50％左右，1周时均降到正常范围，黄疸消退。当胆道支架堵塞时，行支架置换术或再次置入支架，均成功减黄。置入十二指肠金属内支架后，患者的消化道梗阻症状得到缓解，可进食。当肠道梗阻再发时，再次置入十二指肠内支架。其中1例患者先后共置放3枚十二指肠金属内支架。4例患者均无支架置入术相关并发症发生。死亡2例，其中1例置入支架后生存24个月，1例生存22个月，直至临终均无黄疸及肠梗阻症状；另2例患者仍在随访中，1例置入支架术后16个月，1例9个月，目前均无黄疸及肠梗阻症状。结论胆道内支架联合十二指肠内支架可以明显改善胰头癌患者的生活质量，是一种有效的姑息性治疗方法。     

胆道支架与十二指肠支架联合应用治疗胆道消化道梗阻

目的评价联合应用双支架治疗胆道及十二指肠梗阻的疗效。方法20例患者实施治疗。16例患者先经过经皮肝穿刺置入胆道支架解决胆道梗阻,患者出现十二指肠梗阻的症状后,14例患者经口腔、2例患者经胃造瘘口置入十二指肠支架。有4例患者同时有胆道和十二指肠梗阻的症状,同时置入胆道和十二指肠支架。结果所有患者都成功置入了双支架,没有出现并发症和再梗阻的表现。生存期1~14个月,平均5个月。结论联合双支架置入是治疗胆道和十二指肠梗阻的有效的方法。     

内支架置入结合动脉内化疗治疗十二指肠恶性梗阻

目的通过内支架放置及结合动脉插管化疗治疗十二指肠恶性梗阻，延长生命，解除症状。方法十二指肠恶性梗阻病例１４例（男５例，女９例），年龄２０～６９岁，经口置入自扩式十二指肠金属支架共１５枚。其中１２例在支架置入后定期行肿瘤供血动脉插管灌注化疗。结果所有病例梗阻症状解除，除２例未行动脉化疗者外，生存期均明显延长。结论本疗法为十二指肠恶性狭窄提供了有效的治疗经验。     

Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

Purpose The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42–80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting.     

Metallic stents in the treatment of duodenal obstruction: technical issues and results.

OBJECTIVE: To evaluate the efficacy of duodenal stenting procedures and to review technical issues with these procedures in a series of cases over a 1-year period. METHODS: Expandable metallic stents (Wallstents) of varying sizes were introduced and deployed in 4 patients (1 man and 3 women 42 to 81 years of age). Each patient underwent a separate method of stent introduction with either fluoroscopic or endoscopic guidance, either perorally, transgastrically and transhepatically. RESULTS: All procedures were technically successful, allowing patients to continue eating normally. In 1 patient, stent foreshortening necessitated the introduction of a second stent. Another patient experienced transient stent obstruction by food; this resolved spontaneously and required no additional intervention. Based on the patients' continuing ability to tolerate food, it was believed that the stents remained patent until the time of death (from 3 days to 9 weeks with a mean of 5.25 weeks). CONCLUSIONS: Duodenal stenting procedures provide a relatively new, technically feasible and efficacious method of managing duodenal obstructions, especially in patients who are poor candidates for surgery.     

Gastric and duodenal obstruction in patients with cholangiocarcinoma in the porta hepatis: increased prevalence after radiation therapy.

OBJECTIVE. Our objective was to study the imaging findings in patients who had gastric and duodenal obstruction as a long-term complication of cholangiocarcinoma and to determine if the obstruction was associated with radiation therapy. MATERIALS AND METHODS. Between 1973 and 1989, 96 patients had either curative resection or palliative stenting for cholangiocarcinoma involving the hepatic duct bifurcation. Sixty-three (66%) also received adjuvant radiation therapy ranging from 4960 to 7220 rad (cGy). Gastric outlet or duodenal obstruction or both developed subsequently in seven of the 63 patients treated with radiation therapy. Radiographic studies, including upper gastrointestinal series and CT, and medical and surgical records for these seven patients were retrospectively reviewed. RESULTS. Upper gastrointestinal series in the seven patients with obstruction showed narrowing of the lumen, deformity and enlargement of gastric and duodenal mucosal folds, and delayed gastric emptying. CT performed in five of the seven patients showed thickening of the wall of the gastric antrum and small bowel and retained food and fluid within the stomach. All seven patients required gastrojejunostomy; at surgery, dense adhesions and fibrosis were found, and it was not evident whether the obstruction was due to the tumor or to radiation fibrosis. However, because this complication was seen only after radiotherapy, it was presumed to be radiation fibrosis. CONCLUSION. Our experience suggests that radiation therapy increases the risk of postoperative gastric and duodenal obstruction in patients undergoing surgery for cholangiocarcinoma.     

经皮肝穿刺胆道引流联合支架植入治疗恶性梗阻性黄疸疗效观察

目的探讨经皮肝穿刺胆道引流（PTCD）及胆道支架治疗恶性梗阻性黄疸的安全性及短期疗效。方法回顾性分析PTCD及胆道支架治疗恶性梗阻性黄疸患者112例,选择其中具有完整资料的78例作为研究对象,其中PTCD19例,胆道引流及胆道支架植入治疗59例。评价其手术成功率、临床疗效及并发症发生率。结果 78例经皮肝穿刺技术成功率100%,术后1周总胆红素平均水平从术前的（373.2±150.7）μmol/L降至（135.6±60.7）μmol/L（P〈0.001）,肝功能改善明显。总体有效率为88.46%（69/78）,平均生存时间为10.7个月。结论 PTCD联合胆道支架是一种安全、有效的治疗恶性梗阻性黄疸的治疗手段,可有效改善肝功能,为进一步治疗肿瘤创造条件。     

Acute Duodenal Obstruction After Percutaneous Placement of Metallic Biliary Stents: Peroral Treatment with Enteral Stents

Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention.     

新生儿十二指肠梗阻的X线诊断

目的探讨新生儿十二指肠梗阻的X线表现及鉴别诊断。方法回顾性分析52例经外科手术证实为十二指肠梗阻的X线资料,每例均行腹部直立位片检查,其中28例行上消化道泛影葡胺检查,36例行钡剂或泛影葡胺灌肠辅助检查。结果腹部直立片见“单泡征”9例,“双泡征”29例,“三泡征”6例,阶梯状多个短小气液平8例。上消化道造影检查显示十二指肠完全梗阻14例,不完全梗阻13例,其中显示空肠位置异常8例。结肠造影检查显示回盲部位置异常30例,伴细小结肠10例。52例中,肠旋转不良34例,十二指肠闭锁9例,十二指肠狭窄4例,环状胰腺5例。结论结合临床病史及腹部直立位片可对十二指肠梗阻做出诊断,鉴别诊断需做上消化道泛影葡胺造影和灌肠辅助检查。     

新生儿十二指肠梗阻59例X线分析

目的　探讨新生儿十二指肠梗阻的X线表现。资料与方法　回顾性分析 5 9例新生儿十二指肠梗阻的临床及X线资料 ,其中肠旋转不良 2 7例 ,十二指肠闭锁 2 2例 ,十二指肠狭窄 5例 ,环状胰腺 1例 ,肠旋转不良合并十二指肠闭锁 4例。结果　平片主要表现为单泡 (2 /5 9)、双泡 (48/5 9)、三泡 (5 /5 9)征 ,4 8例双泡征中 14例Dd/Ds(十二指肠泡直径 /胃泡直径 )≥ 1.0 ,其中完全性梗阻 13例 ,与不全性梗阻 1例有显著差异 (P <0 .0 1)。上消化道钡餐显示梗阻端形态呈圆顶状 32例 ,鸟嘴状 2例 ,束腰状 6例 ,不规则状 19例 ;14例显示空肠位置异常。钡灌肠显示盲肠位置异常 7例 (7/10 )。结论　双泡征是十二指肠梗阻最常见的X线征象 ;Dd/Ds≥ 1.0时 ,提示完全性梗阻 ;梗阻端形态对判断十二指肠梗阻的病因帮助不大