胆道、十二指肠支架置入治疗胆道合并十二指肠恶性梗阻

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（percutaneoustranshepaticinsertionofbiliarystent，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（endoscopicretrogradecholangiopancreatography—guidedbiliarystent，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（O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。

Clinical Effectiveness of Combined Biliary and Duodenal Stent Placement for Malignant Biliary and Duodenal Obstruction

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 eholangiopancreatography-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 re- obstruction 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.