Srikureja Wichit, Chang Kenneth J
Division of Gastroenterology, University of California-Irvine, Orange, California, USA.
Curr Opin Gastroenterol. 2005 Sep;21(5):601-5. doi: 10.1097/01.mog.0000172750.05280.02.
Endoscopic therapies have become an indispensable modality in the treatment and palliation of complications from pancreatic adenocarcinoma. This review focuses on treatment of biliary obstruction, malignant gastric outlet obstruction, and intractable abdominal pain resulting from unresectable pancreatic adenocarcinoma. Novel and emerging endoscopic approaches are also briefly discussed.
Endoscopic placement of a biliary stent is the modality of choice for palliation of biliary obstruction. Biliary self-expanding metal stents should be placed if expected survival is more than 6 months and plastic stents if expected survival is less than 6 months. For endoscopic palliation of gastric outlet obstruction, enteral self-expanding metal stents should be placed. Biliary self-expanding metal stents should be considered prior to the placement of a duodenal stent. Palliation of intractable abdominal pain can safely be performed with endoscopic ultrasound-guided celiac plexus neurolysis using bupivacaine and absolute alcohol. Exciting novel endoscopic approaches are being evaluated especially in the area of drug-eluted biliary stents, endoscopic creations of enteral anastomoses, and endoscopic ultrasound-guided injection of gene vectors.
The frontier of endoscopic palliative therapies for pancreatic adenocarcinoma is expanding. Clinical trials are needed to evaluate novel endoscopic approaches.
内镜治疗已成为胰腺癌并发症治疗和姑息治疗中不可或缺的方式。本综述重点关注不可切除胰腺癌所致胆管梗阻、恶性胃出口梗阻及顽固性腹痛的治疗。还简要讨论了新出现的内镜治疗方法。
内镜下放置胆管支架是缓解胆管梗阻的首选方式。如果预期生存期超过6个月，应放置胆道自膨式金属支架；如果预期生存期不足6个月，则应放置塑料支架。对于内镜下缓解胃出口梗阻，应放置肠道自膨式金属支架。在放置十二指肠支架之前，应考虑放置胆道自膨式金属支架。使用布比卡因和无水酒精通过内镜超声引导下腹腔神经丛阻滞可安全地缓解顽固性腹痛。尤其在药物洗脱胆管支架、内镜下肠道吻合术及内镜超声引导下基因载体注射等领域，令人兴奋的新内镜治疗方法正在评估中。
胰腺癌内镜姑息治疗的前沿正在拓展。需要进行临床试验以评估新的内镜治疗方法。
