67例肝门部胆管癌内镜下治疗的临床分析  

The clinical characteristics of sixty-seven patients with hilar cholangiocarcinoma treated with endoscopy

作　　者：宛新建[1] 李兆申[1] 孙振兴[1] 邹多武[1] 王娜[1] 

机构地区：[1]上海长海医院消化科,200433

出　　处：《中华消化杂志》2008年第1期15-18,共4页Chinese Journal of Digestion

摘　　要：目的探讨肝门部胆管癌患者内镜下支架治疗的临床效果，为置人支架方式的选择提供依据。方法选择67例肝门部胆管癌患者，根据磁共振胰胆管造影（MRCP）和逆行胰胆管造影（ERCP）对患者Bismuth分型进行比较。ERCP下胆管狭窄部分别置入金属和塑料支架，观察患者术前、术后临床表现及肝功能指标。随访1年观察患者生存情况。结果MRCP与ERCP对患者Bismuth分型结果基本相似，仅对I型与Ⅳ型判断略有偏差。所有患者中置人金属支架21例，双侧塑料支架10例，单侧塑料支架36例。术后1周腹痛、发热及消化不良症状的发生率较术前显著降低（P〈0．05），术后1个月黄疸发生率均较术前显著降低（P〈0．01）。术后1个月血清总胆红素、直接胆红素、丙氨酸转氨酶、碱性磷酸酶和γ-谷氨酰转肽酶值均较术前显著降低（P〈0．05）。ERCP术后1个月，单侧金属支架组与双侧塑料支架组患者血清总胆红素、直接胆红素及碱性磷酸酶值较单侧塑料支架组显著降低（P〈0．05），而金属支架组与双侧塑料支架组患者间肝功能差异无统计学意义（P〉0．05）。结论内镜下支架置人术能显著缓解肝门部胆管癌患者，尤其是出现阻塞性黄疸者的临床症状。Objective To investigate the therapeutic effect of endoscopic stenting in patients with hilar cholangiocarcinoma. Methods Sixty-seven patients with hilar cholangiocarcinoma diagnosed by CT, MRI, megnetic resonance cholangiopancreatography（MRCP） and endoscopic retrograde cholangiopancreatography（ERCP） were enrolled. The Bismuth typing by MRCP and ERCP was compared. Either metal or plastic stents were placed at the bile sticture under ERCP. The clinical features and liver functions before and after precedure were investigated. All patients were followed up to one year. Results The Bismuth typing by MRCP was similar to ERCP, except type Ⅰ and type Ⅳ. Metal stents were placed in 21 patients. Double plastic stents placed in 10 patients. Single plastic stent were placed in 36 patients. The abdominal pain, fever, dyspepsia and jaundice were significantly decreased after the procedure （P ~ 0.05）. The serum levels of the total bilirubin（TB）, direct bilirubin（DB）, ALT, alkaline phosphatase（AKP） and CA19-9 were also decreased one month after the procedure （P 〈 0.05）. The levels of TB, DB and AKP in patients placed with the metal stents or the double plastic stents were significantly lower than those with single plastic stents （P 〈0.05）. Conclusions The endoscopic stenting may improve the clinical menifestations of the patients with hilar cholangiocarcinoma, especial in patients with biliary obstruction.

关 键 词：胆管癌 胆管 肝内 支架 内镜治疗 

分 类 号：R686[医药卫生—骨科学]