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目的探讨恶性胆、肠梗阻患者内镜下同期实施胆、肠双自膨胀金属支架(self-expanding metallic stent,SEMS)治疗的策略、方法及其安全性和有效性。方法回顾性分析2009年1月至2012年6月我院收治的阻塞性黄疸合并十二指肠恶性狭窄行内镜下同期置放胆、肠双SEMS患者的临床资料,分析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(GOOSS)评分情况。结果共收治10例同期放置胆、肠双SEMS的患者,包括胰腺癌5例、胆囊癌2例、胆管癌2例及十二指肠乳头癌1例。5例Ⅰ型肠狭窄(病变未侵及十二指肠乳头)患者置入肠道SEMS后再行内镜逆行胆胰管造影(ERCP)成功放置胆道SEMS。另1例Ⅰ型肠狭窄患者放置长度9cm的肠道SEMS后,再行超声内镜下顺行胆胰管造影(EACP),经超声内镜引导下胆管引流(EUS-BD)放置胆道SEMS;3例Ⅱ型狭窄(病变侵及十二指肠乳头)患者行EACP,经EUS-BD放置胆道SEMS后,再经内镜置入肠道SEMS。1例Ⅲ型肠狭窄(远离十二指肠乳头)患者分别置入胆、肠SEMS。内镜操作成功率为100%。内镜操作术中2例Ⅰ型肠狭窄患者在内镜通过肠狭窄段时有肠壁自限性出血,未发生持续出血或穿孔等与内镜操作相关的并发症。黄疸消退及GOOSS评分改善明显。结论对于胆道梗阻合并十二指肠狭窄不能手术切除患者,结合不同的内镜处理方式同期置入胆、肠双SEMS姑息性解除胆、肠梗阻是可行且安全、有效的。
Objective To investigate the strategy, safety, safety and efficacy of endoscopic simultaneous self-expanding metallic stent (SEMS) in patients with malignant gallbladder and intestinal obstruction. Methods The clinical data of patients with obstructive jaundice combined with malignant stenosis of duodenal ducts admitted from January 2009 to June 2012 in our hospital were retrospectively analyzed. The success rate of endoscopic operation was analyzed And complications, postoperative jaundice and gastric outflow obstruction rating system (GOOSS) score. Results A total of 10 patients with simultaneous gallbladder and intestine double SEMS were treated, including 5 cases of pancreatic cancer, 2 cases of gallbladder carcinoma, 2 cases of cholangiocarcinoma and 1 case of duodenal papillary carcinoma. Five patients with type Ⅰ intestinal stenosis (lesions without invasion of duodenal papilla) underwent endoscopic retrograde cholangiopancreatography (ERCP) with intestinal SEMS. Another 1 case of type Ⅰ intestinal stenosis after the placement of intestinal gut length 9cm, and then under ultrasound endoscopic cholangiopancreatography (EACP), guided by endoscopic biliary drainage (EUS-BD) placed biliary SEMS; EACP was performed in 3 patients with type Ⅱ stenosis (lesions invading the duodenal papilla). After the biliary SEMS was placed on the EUS-BD, the intestine was placed in the intestine by SEMS. One case of type Ⅲ intestinal stenosis (far from duodenal papilla) were placed in gallbladder and intestine SEMS. Endoscopic success rate was 100%. Endoscopic surgery in 2 patients with type Ⅰ intestinal stenosis in intestinal endoscopic stenosis by bowel self-limiting bleeding, no continuous bleeding or perforation and other endoscopic operation-related complications. Jaundice subsided and GOOSS scores improved significantly. Conclusions In patients with biliary obstruction complicated with duodenal stricture, patients with unresectable biliary stricture and duodenal stricture combined with different endoscopic treatments are feasible and safe and effective in relieving gallbladder and intestinal obstruction.