Akinci Devrim, Akhan Okan, Ozkan Fuat, Ciftci Turkmen, Ozkan Orhan S, Karcaaltincaba Musturay, Ozmen Mustafa N
Department of Radiology, Hacettepe University School of Medicine, 06100 Sihhiye, Ankara, Turkey.
Cardiovasc Intervent Radiol. 2007 Nov-Dec;30(6):1173-7. doi: 10.1007/s00270-007-9045-2. Epub 2007 May 29.
The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance.
A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach.
Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively.
Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting.
本研究旨在评估在荧光透视引导下联合金属支架置入术缓解恶性胆管和十二指肠梗阻的疗效。
对9例行胆管和十二指肠支架置入术的患者（6例男性，3例女性）进行回顾性分析。患者的平均年龄为61岁（范围：42 - 80岁）。梗阻原因分别为7例胰腺癌、1例胆管细胞癌和1例十二指肠癌。4例患者同时置入胆管和十二指肠支架。另外5例患者在出现十二指肠梗阻症状后，于胆管支架置入术后置入十二指肠支架。2例患者经胃途径推进十二指肠支架。
技术成功率为100%。经皮胆管引流和支架置入术后，6例患者胆红素水平降至正常，其余3例患者胆红素水平平均降低71%。1例患者出现肿瘤向内生长，在初次手术后90天进行了经皮胆管再次支架置入术。9例患者中，6例能够耐受固体食物，2例能够耐受流食，1例无任何改善。胆管和十二指肠支架置入术后的平均生存期分别为111天和73天。
在无内镜辅助的情况下，于荧光透视引导下联合胆管和十二指肠支架置入术是可行的，且是缓解恶性胆管和十二指肠梗阻的有效方法。如果经口和内镜途径失败，经皮胃造口途径可实现十二指肠支架置入。
