多途径置金属支架治疗晚期恶性梗阻性黄疸162例  

Different approaches of metal stent placement for advanced malignant obstructive jaundice in 162 patients

作　　者：侯森林[1] 乔娜[1] 乔占英[1] 康建省[1] 高永平[1] 张立超[1] 韩锦胜[1] 

机构地区：[1]河北医科大学第二医院微创外科,河北石家庄050000

出　　处：《临床荟萃》2011年第21期1865-1867,共3页Clinical Focus

摘　　要：目的探讨应用多途径置金属支架治疗晚期恶性梗阻性黄疸的效果,为临床上选择更适当的方法治疗晚期恶性梗阻性黄疸提供依据。方法回顾分析162例晚期恶性梗阻性黄疸患者经内镜逆行胰胆管造影(ERCP)途径(n=129)、经皮经肝胆管引流(PTCD)途径(n=25)、联合ERCP和PTCD途径(n=8)置入金属支架治疗的情况。通过比较患者术前与术后1周肝功能指标,总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)的变化,评价3种方法的有效性。结果术后1周复查血清生化指标,TBIL、DBIL、IBIL、ALT、AST均显著下降(P<0.01)。并发症发生主要是感染、出血、胰腺炎,经治疗后缓解,没有操作相关的死亡发生。3种方法均显著降低了肝功能指标,术后并发症在ERCP与PTCD组之间差异无统计学意义(P>0.05)。ERCP+PTCD因例数少,未见有并发症。结论多途径置金属支架治疗晚期恶性梗阻性黄疸的疗效确切,应该根据患者的具体情况选用合适的途径解除患者的黄疸、改善肝功能,提高生存质量。Objective To discuss the curative effect of different ways in metal stent placement for advanced malignant obstructive jaundice for the basis in selecting a better method in clinic. Methods Treatment on 162 cases of malignant biliary obstruction were reviewed retrospectively,whose biliary stent insertions were through endoscopic retrograde cholangiopancreatography（ERCP）（n=129）,percutaneous transhepatic cholangial drainage（PTCD）（n=25）,ERCP joint PTCD（n=8）.By comparison in liver function indexes before and after operation,including total bilirubin（TBIL）,direct bilirubin（DBIL）,indrect bilirubin（IBIL）,alanine amintransferase（ALT）,and aspartate transaminase（AST）,the efficacy of three approaches were evaluated. Results Compared with before operation,TBIL,DBIL,IBIL,ALT and AST decreased one week after the stent insertion（P0.01）.The main complications were infection,hemorrhage,pancreatitis.The patients had remission after treatment and there was no operation-related death happened.Three approaches all significantly reduced the levels of liver function indexes,and post-operation complications showed no statistic difference between ERCP and PTCD（P0.05）.ERCP＋PTCD presented no post-operation complication,due to fewer cases. Conclusion The curative effect for different approaches of metal stent placement in treatment of advanced malignant obstructive jaundice is definite.Each method should be chosen according to the patients＇ condition so as to remove the jaundice and improve the liver function and the quality of life.

关 键 词：黄疸 阻塞性 支架 胆道 穿刺术 胰胆管造影术 内窥镜逆行 

分 类 号：R575.6[医药卫生—消化系统]