内镜下同期放置双侧金属胆道支架的方法探讨

目的 探讨经内镜同期置入双侧可膨式金属胆道支架的方法。方法9例Ⅱ～Ⅳ型肝门部胆管恶性梗阻患者，平均血胆红素（162．8±193．8）μmol／L，内镜下插入双导丝分别留置在左、右侧胆管内，在充分扩张狭窄段后，逐一插入金属支架至双侧肝管予以释放。观察操作的便利性、成功率、控制黄疸有效性、早期并发症和近期的临床疗效。结果全组均一次成功置入双侧支架，分别采用“Y”型支架置入法2例、塑料支架过渡法1例和并行支架法6例，平均耗时（38．1±14．8）min，以并行法置入且留置支架末端在乳头外的方法最为便捷。9例患者术后除1例外其他黄疸均迅速消退，3周内均退至正常，无明显并发症发生。结论同期置人双侧金属支架是安全可行的，可迅速有效地控制肝门部肿瘤所致的黄疸和胆道感染；采用特殊设计的金属支架并行置入，并将支架末端留置在乳头外，是较为简便效佳的方法。

Simultaneous endoscopic bilateral placement of biliary metal stent: a pilot study of 9 cases

Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.