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目的探讨经内镜同期置入双侧可膨式金属胆道支架治疗肝门部胆管恶性梗阻的安全性与有效性。方法收集2007年5月至2010年12月期间因肝门部胆管恶性梗阻而接受内镜下同期双侧金属支架置入患者,记录技术成功率、引流有效率、随访ERCP相关性并发症、支架通畅期与生存期。结果共有24例肝门部胆管恶性梗阻患者接受内镜下同期双侧金属支架置入,完成随访21例,平均随访时间39个月。技术成功率为100%,平均耗时(36.2±13.9)min,引流有效率为95.45%(21/22)。ERCP后发生胆管炎2例,无胰腺炎、消化道出血、穿孔及ERCP相关性死亡病例。7例患者随访期内支架失效,其中4例患者再次置入塑料支架,1例行PTCD后症状缓解,其余2例行保守治疗。支架中位通畅期为253 d(95%CI:199.79~306.21),BismuthⅡ、Ⅲ、Ⅳ型间通畅期差异无统计学意义(P=0.576);中位生存期为229 d(95%CI:154.53~303.47),BismuthⅡ、Ⅲ、Ⅳ型间生存期差异无统计学意义(P=0.748)。结论经内镜同期置入双侧金属支架治疗肝门部胆管恶性梗阻是可行、安全和有效的。
Objective To investigate the safety and efficacy of double-sided expandable metal biliary stent placed endoscopically in the treatment of malignant obstruction of hilar bile duct. Methods The patients with malignant obstruction of hilar biliary tract underwent endoscopic simultaneous metal stent implantation from May 2007 to December 2010 were enrolled. The success rate of the technique, drainage efficiency, follow-up of ERCP-related complications, stent Patency and survival. Results A total of 24 patients with hilar cholangiocarcinoma underwent endoscopic endoscopic bilateral metal stent implantation. Twenty-one patients were followed up with a mean follow-up of 39 months. The technical success rate was 100%, the average time-consuming (36.2 ± 13.9) min, drainage efficiency was 95.45% (21/22). Two cases of cholangitis occurred after ERCP without pancreatitis, gastrointestinal bleeding, perforation and ERCP-related deaths. During the follow-up period, the stent failed in 7 patients. Four patients were re-placed in plastic stent. The symptoms were relieved in 1 patient after PTCD. The remaining 2 patients were treated conservatively. The median duration of patency was 253 days (95% CI: 199.79-306.21). There was no significant difference between the Bismuth II, III and IV types (P = 0.576). The median survival time was 229 days (95% CI: 154.53 ~ 303.47). There was no significant difference in survival time between Bismuth Ⅱ, Ⅲ and Ⅳ (P = 0.748). Conclusions It is feasible, safe and effective to treat the hilar cholangiocarcinoma obstruction by endoscopic simultaneous placement of bilateral metal stents.