内镜双支架引流术治疗晚期肝门部胆管恶性梗阻的疗效评价

目的评价内镜下双支架引流术治疗晚期肝门部胆管恶性梗阻的疗效。方法2007年1月至2010年12月接受内镜下双支架引流治疗的晚期肝门部胆管恶性梗阻患者28例（双支架组），男15例、女13例，年龄44—88岁，中位年龄66．4岁，其中BismuthII型9例，Ⅲa型8例，IIIb型5例，Ⅳ型6例；同期接受内镜下单支架引流治疗的晚期肝门部胆管恶性梗阻患者23例（单支架组）作为对照，男11例、女12例，年龄42～83岁，中位年龄65．8岁，其中Bismuth11型7例，IIa型5例，IIIb型6例，Ⅳ型5例。对2组引流成功率、并发症发生率、平均支架通畅时间及平均生存时间进行对比分析。结果2组支架均成功置入，无死亡病例。引流有效率、并发症发生率双支架组分别为96．4％（27／28）和17．9％（5／28），单支架组分别为87．0％（20／23）和13．0％（3／23），2组比较差异无统计学意义（P〉0．05）。双支架组失访5例，随访率82．1％（23／28）；单支架组失访4例，随访率82．6％（19／23）。双支架组随访的23例患者的平均支架通畅时间、平均生存时间分别为（129±48．5）d和（187±94．5）d，单支架组随访的19例患者的平均支架通畅时间、平均生存时间分别为（102±37．8）d和（103±98．5）d，双支架组均明显优于单支架组（P〈0．05）。结论BismuthII型以上的肝门部胆管恶性梗阻行内镜下双支架引流是安全可行的，其平均支架通畅时间和平均生存时间均优于内镜下单支架引流。

Assessment of endoscopic drainage with biliary double stents for advanced malignant hilar biliary obstruction

Objective To evaluate the therapeutic effects of endoscopic biliary double stents for advanced malignant hilar biliary obstruction.Methods From January 2007 to December 2010,double stents was attempted in 28 patients (15 men and 13 women,median age 66.4 years (44-88 years),including 9 with Bismuth Ⅱ,8 with type Ⅲa,5 with type Ⅲb and 6 with type Ⅳ.A total of 23 consecutive patients ( 11 men and 12 women,median age 65.8 years (42-83 years) with malignant hilar obstruction undergoing a therapy with single stent were recruited as the control group,including 7 with Bismuth Ⅱ,5 with Ⅲa,6 with Ⅲlb and 5 with Ⅳ.The rates of successful drainage,complications,mean survival time of patients and the average duration of biliary stent patency were compared between the two groups.Results Successful rate of cannulation was both 100％ in the two groups.Successful rate of drainage and complications of double stent group were 96.4％ (27/28) and 17.9％ (5/28),and these two variables of single stent group were 87.0％ (20/23) and 13.0％ (3/23),which were not significantly different (P ＞0.05).23 patients (82.1％ ) in double stent and 19 ( 82.6％ ) in single stent group were followed up.The average duration of stent patency and mean survival time of double stent group were ( 129 ±48.5) d and ( 187 ±94.5) d,which were superior to those of the single stent group,i.e.( 102 ±37.8) d and ( 103 ±98.5) d.Conclusion Double stenting is an effective therapy for malignant hilar obstruction of Bismuth Ⅱ and above.It is superior to single stent method in the mean duration of patency and mean survival time.