经皮穿肝胆道引流术(PTCD)辅助支架置放治疗胆管和十二指肠恶性梗阻

 目的 总结采用经皮穿肝胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)及经PTCD途径逆行建立输送通道置放十二指肠支架治疗胰头癌、十二指肠乳头癌伴发胆道梗阻及十二指肠梗阻的体会,评价该方法的可行性和有效性。方法 3例高龄女性患者,年龄88～92岁,CT、MRI或胃镜检查诊断为胰头癌胆道梗阻2例,十二指肠乳头癌1例。3例患者均接受了PTCD术,其中2例患者在胆道内置放金属内支架,1例患者置放外引流导管。3例患者均在PTCD术后2.5～4个月出现十二指肠道梗阻。经PTCD途径逆行插入导丝,再经食管从口腔拉出,用作辅助导丝,在辅助导丝支撑下建立输送通道,通过支架输送系统置放支架。结果 3例患者支架置入后能进流质或半流质饮食。3例患者分别随访29、28、7个月,支架通畅,患者全身状况好。结论 联合采用PTCD及经PTCD途径逆行建立输送通道置放十二指肠支架治疗低位十二指肠梗阻方法可行,疗效确切。

Treatment of malignant duodenal obstruction by establishment retrograde delivery channel through the route of percutaneous transhepatic cholangial drainage(PTCD) combine with stent

Objective To summarize the treatment of biliary and duodenal obstruction due to pancreatic cancer and duodenal cancer by percutaneous transhepatic cholangial drainage(PTCD),and the establishment retrograde delivery channel through the route of PTCD to place duodenal stents.Then to evaluate the feasibility and effectiveness of this approach.Methods Three cases of elderly female patients,aged 88-92 years.Two cases of pancreatic cancer bile duct obstruction and 1 case of duodenal cancer were diagnosed by CT,MR or gastroscopy.All patients accepted the treatment of PTCD,and 2 of these patients accepted metal biliary stents placement.However,2.5-4 months later,duodenal obstruction occurred in all cases.Retrograde delivery channel was established through the route of PTCD,and duodenal stents were placed.Results All patients were able to eat liquid or semi-liquid diet after duodenal stenting.The average duodenal obstructive segment length were 9.7 cm.The patients were followed up for 29 months,28 months and 7 months respectively,stents were patency and all of them had good systemic condition.Conclusions PTCD combine with establishment retrograde delivery channel through the route of PTCD to delivery duodenal stents in the treatment of malignant biliary and duodenal obstruction is feasible and has a good clinical application prospect.