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目的探讨胆、胰管良恶性狭窄或梗阻时内镜双支架联合引流的操作技术及其临床疗效。方法所有患者先行经内镜逆行胰胆管造影,了解胆、胰管狭窄或梗阻的部位、程度,并确定置入支架的外径及长度;然后胆、胰管分别置入导丝,并在导丝引导下按常规分别置入胆管和胰管引流支架。术后观察血清淀粉酶变化及黄疸、腹痛、腹泻等临床症状的改善情况。结果14例胆、胰管并存狭窄或梗阻患者(壶腹癌5例、胰头癌4例、乳头部癌3例及胰头部慢性炎症2例)均一次操作成功,置入胆管塑料支架14根(12例1根,1例2根),置入金属支架1根;同时还置入胰管支架14根。术后2周、1个月及3个月黄疸消失率分别为50.0%、71.0%和93.0%,术后2周上腹痛缓解率为75.0%;7例腹泻患者,术后1个月5例症状消失,2例明显减轻。未发生与操作相关的早期并发症,术后3个月未发现支架移位及阻塞情况。结论胆、胰管良恶性狭窄患者经内镜双支架联合引流是一种简便、安全、有效的治疗方法,既能解除黄疸,又能减压止痛,改善胰腺外分泌功能。
Objective To explore the operative technique and clinical efficacy of endoscopic double stent combined with drainage of benign and malignant biliary and pancreatic duct stenosis or obstruction. Methods All patients underwent endoscopic retrograde cholangiopancreatography to understand the site and degree of stenosis or obstruction of the bile duct and pancreatic duct and to determine the external diameter and length of the stent. Then the bile duct and pancreatic duct were placed in the guide wire, Under the guidance of silk, respectively, according to conventional placement of biliary and pancreatic duct drainage stent. Postoperative changes in serum amylase and jaundice, abdominal pain, diarrhea and other clinical symptoms improved. Results A total of 14 patients with biliary and pancreatic duct stenosis or obstruction (5 ampullary carcinoma, 4 pancreatic cancer, 3 papillary carcinoma and 2 chronic pancreatitis) were operated successfully and placed in biliary plastic stent 14 Root (12 cases of 1, 2 cases of 1), placed in a metal stent; also placed in pancreatic stent 14. The disappearance rates of jaundice at 2 weeks, 1 month and 3 months after operation were 50.0%, 71.0% and 93.0% respectively. The relief rate of upper abdominal pain at 2 weeks after operation was 75.0%. In 7 diarrhea patients and 1 month after operation, 5 cases Symptoms disappeared, 2 cases significantly reduced. There were no early complications associated with the operation, and no stent displacement and occlusion were found at 3 months postoperatively. Conclusions The biliary and pancreatic duct benign and malignant strictures by endoscopic double stent combined drainage is a simple, safe and effective treatment, both to relieve jaundice, but also decompression and analgesic and improve pancreatic exocrine function.