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目的探讨经内镜置入胆道及十二指肠自膨式金属支架(self-expandable metal stents,SEMS)治疗恶性梗阻性黄疸合并十二指肠梗阻的临床疗效及技术难点。方法对于2014-01/2015-12月作者医院经内镜下置入胆道及十二指肠SEMS的21例恶性梗阻性黄疸并十二指肠梗阻患者的临床资料进行回顾性分析,观察内镜操作的成功率及并发症、术后黄疸消退及胃流出道梗阻评分系统(gastric outlet obstruction scoring system,GOOSS)评分情况。结果 18例经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)成功置入胆道金属支架,成功率85.71%;3例经ERCP置入支架失败者,行经皮肝胆道穿刺置管引流术(percutaneous transhepatic cholangial drainage,PTCD)成功解除梗阻性黄疸;21例十二指肠支架均成功经内镜置入,成功率100%;18例患者胆道金属支架置入术后血清胆红素均明显下降(>30%),血清总胆红素水平由术前的平均(305.89±88.61)μmol/L,下降至(41.59±26.20)μmol/L,(t=17.209,P=0.000);十二指肠支架置入术后18例能进普食或半流食,3例能进流食,术前GOOSS评分为(0.57±0.51)分,术后1周为(2.19±0.67)分(t=6.642,P=0.000)。结论对于无法手术的恶性梗阻性黄疸合并十二指肠梗阻患者,经内镜置入胆道及十二指肠金属支架是一种安全、有效的姑息治疗方法。
Objective To investigate the clinical efficacy and technical difficulties of endoscopic implantation of biliary tract and duodenal self-expandable metal stents (SEMS) in the treatment of malignant obstructive jaundice complicated with duodenal obstruction. Methods The clinical data of 21 patients with malignant obstructive jaundice and duodenal obstruction underwent endoscopic biliary and duodenal SEMS in the hospital from January 2014 to December 2015 were analyzed retrospectively. The success rate of operation and complications, postoperative jaundice regression and gastric outlet obstruction scoring system (GOOSS) score. Results Eighteen patients underwent endoscopic retrograde cholangiopancreatography (ERCP) successfully received biliary metal stent with a success rate of 85.71%. Three patients who underwent ERCP for stent failure were treated with percutaneous transhepatic biliary catheterization percutaneous transhepatic cholangial drainage (PTCD) successfully ruptured obstructive jaundice. 21 cases of duodenal stents were successfully inserted by endoscopy, the success rate was 100%; serum bilirubin were significantly decreased in 18 patients after biliary stenting (T = 17.209, P = 0.000). The level of total bilirubin in serum was significantly lower than that in preoperative (305.89 ± 88.61) μmol / L and (41.59 ± 26.20) μmol / The total score of GOOSS was 0.57 ± 0.51 in preoperative and (2.19 ± 0.67) points in one week after surgery (t = 6.642, P = 0.000). Conclusion For patients with malignant obstructive jaundice complicated with duodenal obstruction, endoscopic biliary and duodenal metal stents are a safe and effective palliative treatment.