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

目的探討經內鏡同期置入雙側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鏡下同期雙側金屬支架置入患者，記錄技術成功率、引流有效率、隨訪ERCP相關性并發(fā)癥、支架通暢期與生存期。 結果共有24例肝門部膽管惡性梗阻患者接受內鏡下同期雙側金屬支架置入，完成隨訪21例，平均隨訪時間39個月。 技術成功率為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相關性死亡病例。 7例患者隨訪期內支架失效，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)計學意義（P=0.748）。 結論經內鏡同期置入雙側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. 內鏡下同期放置雙側金屬膽道支架治療肝門部膽管惡性梗阻療效觀察. 中國普外基礎與臨床雜志, 2011, 18(6): 585-589. doi: 復制

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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. 內鏡下同期放置雙側金屬膽道支架的方法探討 [J]. 中華消化內鏡雜志， 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. 內鏡下同期放置雙側金屬膽道支架的方法探討 [J]. 中華消化內鏡雜志， 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.