• 第二軍醫(yī)大學(xué)附屬東方肝膽外科醫(yī)院內(nèi)鏡科（上海 200438）;

目的探討經(jīng)內(nèi)鏡同期置入雙側(cè)可膨式金屬膽道支架治療肝門部膽管惡性梗阻的安全性與有效性。方法收集2007年5月至2010年12月期間因肝門部膽管惡性梗阻而接受內(nèi)鏡下同期雙側(cè)金屬支架置入患者，記錄技術(shù)成功率、引流有效率、隨訪ERCP相關(guān)性并發(fā)癥、支架通暢期與生存期。 結(jié)果共有24例肝門部膽管惡性梗阻患者接受內(nèi)鏡下同期雙側(cè)金屬支架置入，完成隨訪21例，平均隨訪時間39個月。 技術(shù)成功率為100%，平均耗時（36.2±13.9） min，引流有效率為95.45%（21/22）。 ERCP后發(fā)生膽管炎2例，無胰腺炎、消化道出血、穿孔及ERCP相關(guān)性死亡病例。 7例患者隨訪期內(nèi)支架失效，其中4例患者再次置入塑料支架，1例行PTCD后癥狀緩解， 其余2例行保守治療。支架中位通暢期為253 d （95% CI: 199.79～306.21），Bismuth Ⅱ、Ⅲ、Ⅳ型間通暢期差異無統(tǒng)計學(xué)意義（P=0.576）； 中位生存期為229 d （95% CI： 154.53～303.47），Bismuth Ⅱ、Ⅲ、Ⅳ型間生存期差異無統(tǒng)計學(xué)意義（P=0.748）。 結(jié)論經(jīng)內(nèi)鏡同期置入雙側(cè)金屬支架治療肝門部膽管惡性梗阻是可行、安全和有效的。

引用本文： 高道鍵,胡冰,潘亞敏,王田田,王書智,陸蕊,王淑萍,黃慧,時之梅. 內(nèi)鏡下同期放置雙側(cè)金屬膽道支架治療肝門部膽管惡性梗阻療效觀察. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(6): 585-589. doi: 復(fù)制

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2. Havlik R, Sbisa E, Tullo A, et al. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors [J]. Hepatogastroenterology， 2000, 47(34): 927931.
3. Johnson SR, Kelly BS, Pennington LJ, et al. A single center experience with extrahepatic cholangiocarcinomas [J]. Surgery， 2001, 130(4): 584590.
4. Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion [J]. Gut， 1991, 32(6): 685689.
5. Deviere J, Baize M, de Toeuf J, et al. Longterm followup of patients with hilar malignant stricture treated by endoscopic internal biliary drainage [J]. Gastrointest Endosc， 1988, 34(2): 95101.
6. Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice [J]. Gut， 1989, 30(8): 11321135.
7. Smith AC, Dowsett JF, Russell RC, et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction [J]. Lancet， 1994, 344(8938): 16551660.
8. Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice [J]. Lancet， 1987, 2(8550): 5762.
9. Perdue DG, Freeman ML, DiSario JA, et al. Plastic versus selfexpanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study [J]. J Clin Gastroenterol， 2008, 42(9): 10401046.
10. Davids PH, Groen AK, Rauws EA, et al. Randomised trial of selfexpanding metal stents versus polyethylene stents for distal malignant biliary obstruction [J]. Lancet， 1992, 340(88348835): 14881492.
11. Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial [J]. Endoscopy， 1993, 25(3): 213218.
12. Sherman S. Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we work to place two? [J]. Gastrointest Endosc， 2001, 53(6): 681684.
13. De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study [J]. Gastrointest Endosc， 2001, 53(6): 547553.
14. Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage [J]. Gastrointest Endosc， 1998, 47(5): 354362.
15. Cheng JL, Bruno MJ, Bergman JJ, et al. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of selfexpandable metallic Wallstents [J]. Gastrointest Endosc， 2002, 56(1): 3339.
16. Eisen GM, Dominitz JA, Faigel DO, et al. An annotated algorithmic approach to malignant biliary obstruction [J]. Gastrointest Endosc， 2001, 53(7): 849852.
17. 胡冰, 陸蕊, 徐福寧, 等. 內(nèi)鏡下同期放置雙側(cè)金屬膽道支架的方法探討 [J]. 中華消化內(nèi)鏡雜志， 2009, 26(7): 339343.
18. Bismuth H, Castaing D, Traynor O. Resection or palliation: priority of surgery in the treatment of hilar cancer [J]. World J Surg， 1988, 12(1): 3947.
19. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc， 1991, 37(3): 383393.
20. De Palma GD, Pezzullo A, Rega M, et al. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study [J]. Gastrointest Endosc， 2003, 58(1): 5053.
21. Lee JH, Kang DH, Kim JY, et al. Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent [J]. Gastrointest Endosc， 2007, 66(2): 364369.
22. Dumas R, Demuth N, Buckley M, et al. Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique [J]. Gastrointest Endosc， 2000, 51(3): 334338.
23. Park do H, Lee SS, Moon JH, et al. Newly designed stent for endoscopic bilateral stentinstent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos) [J]. Gastrointest Endosc， 2009, 69(7): 13571360.
24. Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stentwithinstent placement for malignant hilar biliary obstruction [J]. Gastrointest Endosc， 2010, 71(1): 195199.
25. Naitoh I, Ohara H, Nakazawa T, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction [J]. J Gastroenterol Hepatol， 2009, 24(4): 552557.
  1. 1. Guthrie CM, Haddock G, De Beaux AC, et al. Changing trends in the management of extrahepatic cholangiocarcinoma [J]. Br J Surg， 1993, 80(11): 14341439.
  2. 2. Havlik R, Sbisa E, Tullo A, et al. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors [J]. Hepatogastroenterology， 2000, 47(34): 927931.
  3. 3. Johnson SR, Kelly BS, Pennington LJ, et al. A single center experience with extrahepatic cholangiocarcinomas [J]. Surgery， 2001, 130(4): 584590.
  4. 4. Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion [J]. Gut， 1991, 32(6): 685689.
  5. 5. Deviere J, Baize M, de Toeuf J, et al. Longterm followup of patients with hilar malignant stricture treated by endoscopic internal biliary drainage [J]. Gastrointest Endosc， 1988, 34(2): 95101.
  6. 6. Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice [J]. Gut， 1989, 30(8): 11321135.
  7. 7. Smith AC, Dowsett JF, Russell RC, et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction [J]. Lancet， 1994, 344(8938): 16551660.
  8. 8. Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice [J]. Lancet， 1987, 2(8550): 5762.
  9. 9. Perdue DG, Freeman ML, DiSario JA, et al. Plastic versus selfexpanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study [J]. J Clin Gastroenterol， 2008, 42(9): 10401046.
  10. 10. Davids PH, Groen AK, Rauws EA, et al. Randomised trial of selfexpanding metal stents versus polyethylene stents for distal malignant biliary obstruction [J]. Lancet， 1992, 340(88348835): 14881492.
  11. 11. Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial [J]. Endoscopy， 1993, 25(3): 213218.
  12. 12. Sherman S. Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we work to place two? [J]. Gastrointest Endosc， 2001, 53(6): 681684.
  13. 13. De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study [J]. Gastrointest Endosc， 2001, 53(6): 547553.
  14. 14. Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage [J]. Gastrointest Endosc， 1998, 47(5): 354362.
  15. 15. Cheng JL, Bruno MJ, Bergman JJ, et al. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of selfexpandable metallic Wallstents [J]. Gastrointest Endosc， 2002, 56(1): 3339.
  16. 16. Eisen GM, Dominitz JA, Faigel DO, et al. An annotated algorithmic approach to malignant biliary obstruction [J]. Gastrointest Endosc， 2001, 53(7): 849852.
  17. 17. 胡冰, 陸蕊, 徐福寧, 等. 內(nèi)鏡下同期放置雙側(cè)金屬膽道支架的方法探討 [J]. 中華消化內(nèi)鏡雜志， 2009, 26(7): 339343.
  18. 18. Bismuth H, Castaing D, Traynor O. Resection or palliation: priority of surgery in the treatment of hilar cancer [J]. World J Surg， 1988, 12(1): 3947.
  19. 19. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc， 1991, 37(3): 383393.
  20. 20. De Palma GD, Pezzullo A, Rega M, et al. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study [J]. Gastrointest Endosc， 2003, 58(1): 5053.
  21. 21. Lee JH, Kang DH, Kim JY, et al. Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent [J]. Gastrointest Endosc， 2007, 66(2): 364369.
  22. 22. Dumas R, Demuth N, Buckley M, et al. Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique [J]. Gastrointest Endosc， 2000, 51(3): 334338.
  23. 23. Park do H, Lee SS, Moon JH, et al. Newly designed stent for endoscopic bilateral stentinstent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos) [J]. Gastrointest Endosc， 2009, 69(7): 13571360.
  24. 24. Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stentwithinstent placement for malignant hilar biliary obstruction [J]. Gastrointest Endosc， 2010, 71(1): 195199.
  25. 25. Naitoh I, Ohara H, Nakazawa T, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction [J]. J Gastroenterol Hepatol， 2009, 24(4): 552557.