金属和塑料支架置入治疗胰头癌伴阻塞性黄疸的疗效分析  

Endoscopic intervention for obstructive jaundice secondary to pancreatic head cancer; an analysis of 40 cases.

作　　者：宛新建[1] 郑萍[1] 王兴鹏[1] 万荣[1] 周如茵[1] 王娜[1] 茅柳水[1] 

机构地区：[1]上海交通大学附属第一人民医院消化内科,上海200080

出　　处：《胰腺病学》2007年第5期285-287,共3页Chinese JOurnal of Pancreatology

摘　　要：目的分析比较金属与塑料胆管支架治疗胰头癌伴阻塞性黄疸的疗效。方法40例胰头癌伴阻塞性黄疸患者随机分为2组,内镜下分别置入金属支架和塑料支架。观察术前和术后患者发热、腹痛、腹胀、黄疸、WBC、血淀粉酶、总胆红素（TB）、直接胆红素（DB）、ALT、AST、γ-GT、AKP的变化。结果所有患者支架置入成功,术后1个月及6个月X线复查,提示支架仍保持原位及良好的扩张状态。术后发热、腹痛、腹胀、黄疸发生率明显降低（P〈0.05）,WBC、TB、DB、ALT和AST也明显降低（P〈0.05）。金属支架组发热、黄疸的发生率显著低于塑料支架组（P〈0.05）,血胆红素、AKP、ALT水平也较塑料支架组显著降低（P〈0.05）。但金属支架组术后3h血淀粉酶升高较塑料支架组明显（P〈0.05）。随访6月患者未出现死亡。结论胆管支架能有效治疗胰腺癌伴阻塞性黄疸,金属支架的疗效显著优于塑料支架,但其术后发生胰腺炎的风险增高。Objective To analyze the clinical effects of 40 cases with obstructive jaundice secondary to pancreatic head cancer after ERCP with biliary stenting, and compare the effects between metal stems and plastic stems. Methods Forty patients were randomized to receive metal stents or plastic stents. These patients were examined by ERCP to identify the position, extent of the tumor and the length of stenosis, then to dilate the stenosis. After stenting, these patients were closely followedup, and following parameters in the two groups were recorded and compared, including incidence of fever, abdominal pain, bloating, jaundice, white blood cell count （WBC）, serum amylase, total bilirubin （TB）, direct bilirubin （DB）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, γ-glutamyl transpeptidase （γ-GT）, alkaline phosphatase （AKP）. Results The technical success rate was 100% in both groups. At the 1 and 6 month of follow-up, abdominal X-ray plain films showed no signs of stents migration. After stenting, the incidence of fever, abdominal pain, bloating, jaundice, serum levels of WBC, TB, DB, ALT and AST decreased significantly compared with those before stenting （P 〈 0.05）. In metal stents group, the incidence of fever and iaundice and serum levels of TB, DB, ALT and AST were significantly lower than those in plastic stents group. However, the level of serum amylase in metal stents group was significantly higher than that in plastic stems group at 3 h after stenting （P 〈 0.05）. No death occurred at the six month of follow-up. Conclusions The patients with obstructive jaundice secondary to pancreatic head cancer could be managed effectively by biliary stents, the long-term effects of metal stems were superior to plastic stents, but the incidence of post-ERCP pancreatitis was higher in metal stents group.

关 键 词：胰腺肿瘤 黄疸 阻塞性 胰胆管造影 内窥镜逆行 支架 

分 类 号：R735[医药卫生—肿瘤] R57[医药卫生—临床医学]