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.

Treatment of Malignant Biliary and Duodenal Obstruction Using Percutaneous Trans-hepatic Catheterization in Combination with Per-oral Stent Placement

Objective:To study the approach and effectiveness of percutaneous trans-hepatic catheterization in combination with per-oral stent placement in the palliative treatment of malignant biliary and duodenal obstruction.Methods:Of 23 patients having obstructive jaundice caused by malignant biliary and duodenal obstruction,percutaneous trans-hepatic metallic stent were firstly placed in 17 patients in order to reduce the signs and symptoms of jaundice.Duodenal obstruction appeared afterward,automatically expanded metallic duodenal stent was inserted per-orally under fluoroscopy to diminish the gastro-intestinal obstruction.Biliary and duodenal stents were placed simultaneously in 6 patients with documented and symptomatic evidences of biliary ang duodenal obstructions.Serum bilirubin and body weight were measured before and after these procedures and t test were calculated.Results:Of the 23 patients with successful dual-route stents placement,the level of serum bilirubin and body weight before and after operation were significantly improved (P<0.05).After insertion of duodenal stent,immediate relief of obstruction was obtained,all patients were able to take food at the same day without major complications.The result of treatment was satisfactory after 1~20 months follow-up,all patients were able to take food by mouth.Conclusion:Percutaneous trans-hepatic catheterization in combination with per-oral stent placement was an effective approach for palliative treatment of malignant biliary and duodenal obstruction.