经内镜胆管内引流治疗恶性胆道梗阻的探讨  

MANAGEMENT OF MALIGNANT BILIARY OBSTRUCTION WITH ENDOSCOPIC BILIARY DRAINAGE

作　　者：任旭[1] 徐晓红[1] 司丽娟[1] 李晓英[1] 陶铸[2] 小越和荣 

机构地区：[1]黑龙江省医院消化内科,哈尔滨150036 [2]黑龙江省医院B超室,哈尔滨150036 [3]日本新泻县立癌中心病院内科

出　　处：《中华消化内镜杂志》1996年第5期262-265,共4页Chinese Journal of Digestive Endoscopy

摘　　要：为缓解胆道梗阻，对２８例恶性胆道梗阻（ＭＢＯ）患者行经内镜胆管内引流术（ＥＢＤ）。结果２５例（８９％）插管成功，共插管４４次，７Ｆ管３次，１０Ｆ２５次，１２Ｆ１６次。２３例（９２％）减黄有效，ＥＢＤ后第３天胆红素平均下降４６．３％，肝外胆管径平均回缩５８．６％，减黄有效者腹胀迅速消失或减轻。首次插管维持有效引流时间１４１．５±１５１．２天，早、中期并发胆管炎４０％，１年以上生存１７％。结果表明ＥＢＤ减黄效果和症状改善是显著的，胆红素下降与胆管径回缩相平行。认为胆管是否屈曲及乳头括约肌切开术的好坏是ＥＢＤ成败的关键；腹胀再现，有胆道感染症状及Ｂ超见肝外胆管扩张为通管的指征。ＥＢＤ适合高龄或高危人群的ＭＢＯ患者，对延长生存期有重要的价值。Endoscopic biliary drainage (EBD) was performed in 28 patients with malignant biliary obstruction for relief of the obstruction , and its factors of success or failure with regard to stent intser- tion and effect of relieving jaundice as well as indication of irrigation of the stents was evaluated mainly. Endoprosthesis was successfully inserted in 25 cases (89% ) ,with 44 insertions ,among which 7F stents in 3 cases,1OF in 25 cases and 12F in 16 cases were introduced. Obstructive jaundice was improved effectively in 23 cases (92% ) of them. Serum bilirubin levels decreased averagely to 46. 3% and caliber of ex- trahepatic bile duct reduced averagely 5 8. 6% at the third days after EBD. ln the cases with functioning stents abdominal distention was disappeared quickly , or markedly relieved. The time of stents patency was mean 141. 5±151. 2 days after first session of the stents inaertion.Complications of cholangitis with EBD at early and mid period were 40%. Four cases (17%) was alive more than one year. The results showed that effects of relieving jaundice and improving symptoms using EBD were notable , decreased serum bilirubin levels corresponded well with the changes in the caliber of bile duct. We considered that angulation of the bile duct and. the quality of EST are important factors related to success or failure of the stents insertion , and recurring abdominal distention , symptomatic cholangitis and dilated extrahepatic bile duct examined by ultrasond are early indications of irrigation of the stents. We concluded that EBD indicated for elderly and high risk patients with malignant biliary obstruction , it has significant clinical value for extenting life expectancy.

关 键 词：恶性胆道梗阻 经内镜胆管内引流术 

分 类 号：R735.8[医药卫生—肿瘤]