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在支架或经皮肝穿胆道引流(PTBD)引导下,通过专门的十二指肠支架进行内镜下胆道支架置入术,以治疗合并恶性胆道和十二指肠梗阻。

Endoscopic biliary stent insertion through specialized duodenal stent for combined malignant biliary and duodenal obstruction facilitated by stent or PTBD guidance.

作者信息

Lee Jong Jin, Hyun Jong Jin, Choe Jung Wan, Lee Dong-Won, Kim Seung Young, Jung Sung Woo, Jung Young Kul, Koo Ja Seol, Yim Hyung Joon, Lee Sang Woo

机构信息

a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University, Ansan Hospital , Ansan-si , Korea.

出版信息

Scand J Gastroenterol. 2017 Nov;52(11):1258-1262. doi: 10.1080/00365521.2017.1349833. Epub 2017 Jul 7.

Abstract

OBJECTIVES

Endoscopic stenting for combined malignant biliary and duodenal obstruction is technically demanding. However, this procedure can be facilitated when there is guidance from previously inserted stent or PTBD tube. This study aimed to evaluate the feasibility and clinical success rate of endoscopic placement of biliary self-expandable metal stent (SEMS) through duodenal SEMS in patients with combined biliary and duodenal obstruction due to inoperable or metastatic periampullary malignancy.

MATERIALS AND METHODS

A total of 12 patients with combined malignant biliary and duodenal stricture underwent insertion of biliary SEMS through the mesh of specialized duodenal SEMS from July 2012 to October 2016. Technical and clinical success rate, adverse events and survival after completion of SEMS insertion were evaluated.

RESULTS

The duodenal strictures were located in the first portion of the duodenum in four patients (Type I), in the second portion in three patients (Type II), and in the third portion in five patients (Type III). Technical success rate of combined metallic stenting was 91.7%. Insertion of biliary SEMS was guided by previously inserted biliary SEMS in nine patients, plastic stent in one patient, and PTBD in two patients. Clinical success rate was 90.9%. There were no early adverse events after the procedure. Mean survival period after combined metallic stenting was 91.9 days (range: 15-245 days).

CONCLUSIONS

Endoscopic placement of biliary SEMS through duodenal SEMS is feasible with high success rates and relatively easy when there is guidance. This method can be a good alternative for palliation in patients with combined biliary and duodenal obstruction.

摘要

目的

内镜下对恶性胆道和十二指肠联合梗阻进行支架置入术对技术要求较高。然而,若有先前置入的支架或经皮经肝胆道引流(PTBD)管的引导,该操作会更容易。本研究旨在评估对于因无法手术切除或转移性壶腹周围恶性肿瘤导致胆道和十二指肠联合梗阻的患者,经十二指肠自膨式金属支架(SEMS)进行内镜下胆道SEMS置入的可行性及临床成功率。

材料与方法

2012年7月至2016年10月,共有12例恶性胆道和十二指肠联合狭窄患者通过专门的十二指肠SEMS网孔进行了胆道SEMS置入。评估了SEMS置入完成后的技术成功率、临床成功率、不良事件及生存期。

结果

十二指肠狭窄位于十二指肠第一部的有4例(I型),第二部的有3例(II型),第三部的有5例(III型)。联合金属支架置入的技术成功率为91.7%。9例患者的胆道SEMS置入由先前置入的胆道SEMS引导,1例由塑料支架引导,2例由PTBD引导。临床成功率为90.9%。术后无早期不良事件。联合金属支架置入后的平均生存期为91.9天(范围:15 - 245天)。

结论

经十二指肠SEMS进行内镜下胆道SEMS置入是可行的,成功率高,且在有引导时相对容易。该方法可为胆道和十二指肠联合梗阻患者的姑息治疗提供一个良好的选择。

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