Wu Chi-Huan, Lee Mu-Hsien, Tsou Yung-Kuan, Lin Cheng-Hui, Sung Kai-Feng, Pan Kuang-Tse, Liu Nai-Jen
Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Curr Oncol. 2021 Sep 26;28(5):3738-3747. doi: 10.3390/curroncol28050319.
Duodenal obstruction is often accompanied with unresectable malignant distal biliary obstruction in patients who have undergone biliary self-expandable metal stent (SEMS) placement. Duodenobiliary reflux (DBR) is a major cause of recurrent biliary obstruction (RBO) after covered biliary SEMS placement. We analyzed the risk factors for DBR-related SEMS dysfunction following treatment for malignant duodenal obstruction. Sixty-one patients with covered SEMS who underwent treatment for duodenal obstruction were included. We excluded patients with tumor-related stent dysfunction ( = 6) or metal stent migration ( = 1). Fifty-four patients who underwent covered biliary SEMS placement followed by duodenal metal stenting or surgical gastrojejunostomy were included. Eleven patients had DBR-related biliary SEMS dysfunction after treatment of duodenal obstruction. There was no difference between the duodenal metal stenting group and the surgical gastrojejunostomy group. Duodenal obstruction below the papilla of Vater and a score of ≤2 on the Gastric Outlet Obstruction Scoring System after treatment for duodenal obstruction were associated with DBR-related covered biliary SEMS dysfunction. Thus, creating a reliable route for ensuring good oral intake and avoiding DBR in patients with duodenal obstruction below the papilla of Vater are both important factors in preventing DBR-related covered biliary SEMS dysfunction.
十二指肠梗阻常伴有不可切除的恶性远端胆管梗阻，此类患者已接受胆管自膨式金属支架（SEMS）置入术。十二指肠胆管反流（DBR）是覆膜胆管SEMS置入术后复发性胆管梗阻（RBO）的主要原因。我们分析了恶性十二指肠梗阻治疗后DBR相关SEMS功能障碍的危险因素。纳入61例行覆膜SEMS治疗十二指肠梗阻的患者。我们排除了肿瘤相关支架功能障碍患者（n = 6）或金属支架移位患者（n = 1）。纳入54例行覆膜胆管SEMS置入术，随后行十二指肠金属支架置入术或外科胃空肠吻合术的患者。11例患者在十二指肠梗阻治疗后出现DBR相关的胆管SEMS功能障碍。十二指肠金属支架置入组和外科胃空肠吻合术组之间无差异。十二指肠乳头以下的十二指肠梗阻以及十二指肠梗阻治疗后胃出口梗阻评分系统评分≤2分与DBR相关的覆膜胆管SEMS功能障碍有关。因此，为 Vater 乳头以下十二指肠梗阻患者建立可靠的途径以确保良好的经口摄入并避免 DBR，都是预防 DBR 相关覆膜胆管 SEMS 功能障碍的重要因素。
