Maire Frédérique, Hammel Pascal, Ponsot Philippe, Aubert Alain, O'Toole Dermot, Hentic Olivia, Levy Philippe, Ruszniewski Philippe
Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France.
Am J Gastroenterol. 2006 Apr;101(4):735-42. doi: 10.1111/j.1572-0241.2006.00559.x.
Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown.
To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer.
All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival.
One hundred patients, median age 65 yr (32-85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7-29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4-21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5-15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment.
Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival.
采用新的化疗方案后，无法切除的胰腺癌患者的预期寿命有所提高。在大多数情况下，胆道和消化道狭窄可通过内镜进行治疗。然而，这些支架置入术的长期疗效尚不清楚。
评估无法切除的胰腺癌患者胆道和十二指肠狭窄的发生率，以及内镜下置入支架的技术成功率、短期和长期通畅率。
对1999年1月至2003年9月间在本中心就诊的所有连续性胰头无法切除癌患者进行回顾性研究。有胆道和/或十二指肠狭窄的患者接受内镜支架置入作为首选治疗。结果包括技术和临床成功率、支架通畅率及生存率。
研究了100例患者，中位年龄65岁（32 - 85岁），患有局部晚期（62%）或转移性（38%）胰腺癌。83%的患者接受了至少一线化疗。精算中位生存期为11个月（0.7 - 29.3个月）。胆道和十二指肠狭窄分别发生在81例和25例患者中。74例患者（91%）成功置入了胆道支架。首次引入自膨式金属支架时（N = 59），41例患者（69%）置入单个支架就足够了（支架通畅的中位持续时间为7个月（0.4 - 21.1个月））。十二指肠支架置入术在24例患者中成功（96%）；其中，96%的患者只需置入单个支架（支架通畅的中位持续时间为6个月[0.5 - 15.7个月]）。在23例同时发生胆道和十二指肠狭窄的患者中，联合支架置入术在91%的病例中成功。未发生与内镜治疗相关的严重并发症或死亡。
内镜下对胆道和十二指肠狭窄进行姑息治疗长期来看是安全有效的，包括对合并梗阻的患者。即使是生存期较长的患者也很少需要重复操作，因此采用这种姑息治疗是合理的。
