胆道及十二指肠恶性梗阻多支架置入治疗及体会

目的探讨联合应用胆道支架及十二指肠支架治疗胆道及十二指肠恶性梗阻的疗效。方法总结我院3例胆道及十二指肠恶性梗阻患者行胆道及十二指肠支架治疗的资料。1例胃癌复发患者,先经皮经肝穿刺胆道引流术（PTCD）下胆道金属支架置入,然后行胃镜下胃十二指肠支架置入;1例壶腹周围癌患者,十二指肠镜下胆道金属支架及十二指肠内金属支架同时置入,术后因再次黄疸,经十二指肠金属支架网眼再次胆道金属支架内置入胆道塑料支架。1例十二指肠癌患者,先行PTCD胆道内外引流管引流治疗,再通过胆道内外引流管窦道置入胆道金属支架,十二指肠镜下置入胃十二指肠金属支架。结果 3例患者术后总胆红素明显下降,上消化道梗阻症状明显改善,均未发生严重并发症。结论多支架治疗胆道及十二指肠恶性梗阻是一种有效的方法,提高了患者生活质量,但多支架置入的方法应因人而异。

Experience of multiple biliary and duodenal stenting in the treatment of malignant biliary and duodenal obstruction

Objective To investigate the therapeutic effects of combined biliary and duodenal stenting in the treatment of malignant biliary and duodenal obstruction. Methods Medical data concerning 3 cases of malignant biliary and duodenal obstruction treated with combined biliary and duodenal stenting in our hospital were summarized. PTCD biliary metallic stent placement was first performed in one patient with recurrent gastric tumor,and then duodenal stent insertion was done under gastroscopy. Biliary metallic stent and duodenal metal stenting was performed concurrently under duodenoscopy in one patient with periampullary cancer. Due to jaundice after surgery,biliary plastic stenting through duodenal metal stent mesh was performed in the patient. There was one patient with duodenal cancer,who was first treated with inner and outer biliary drainage through PTCD,and then biliary metallic stent was placed through the sinus,and finally duodenal metal stenting was performed under duodenoscopy. Results Total bilirubin after stenting in the 3 patients decreased significantly,and symptoms of upper digestive obstruction were improved considerably,and no serious complications occurred in the 3 patients. Conclusion Multiple metal stenting was an effective method for the treatment of malignant biliary and duodenal obstruction,and could improve the life quality of patients as well. Methods for the placement of multiple stents could be different in one patient from another.