内镜胆道金属支架联合鼻胆管引流姑息性治疗恶性胆道梗阻  

Endoscopic metal biliary endoprosthesis combined with endoscopic nasobiliary drainage for palliative treatment of malignant biliary obstruction

作　　者：韩今朝[1] 秦鸣放[2] 

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津市南开医院,天津微创外科中心,天津市300100

出　　处：《世界华人消化杂志》2013年第6期547-552,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨内镜胆道金属支架置入术(endoscopic metal biliary endoprosthesis,EMBE)联合鼻胆管引流术(endoscopic naso-biliary drainage,ENBD)姑息性治疗恶性胆道梗阻的临床效果及应用价值.方法:回顾了2010-04至2012-10行内镜逆行胆胰管造影术(endoscopic retrograde cholangiopa ncreatography,ERCP)并放置EMBE联合ENBD的68例恶性胆道梗阻患者的临床资料,对其疗效、并发症、术后生存时间及支架通畅时间进行分析.结果:68例患者中行ERCP并放置胆道金属支架成功64例,失败4例,成功率为94.12%(64/68);支架置入术后1wk黄疸明显消退,肝功能各项指标较术前显著改善,黄疸消退有效率为95.31%;术后并发症5例,其中高淀粉酶血症3例,急性胰腺炎1例、急性胆管炎1例,经保守治疗后痊愈;术后随访58例患者,平均生存时间为10.00mo±2.30mo(3-26mo),半年生存率为67.24%(39/58),1年生存率为43.10%(25/58),2年生存率为5.17%(3/58);平均支架通畅时间为4.00mo±2.26mo(0-9mo).结论:胆道金属支架置入术联合鼻胆管引流术可以有效解除胆道梗阻,改善肝功能,同时具有创伤小、疗效确切、并发症少、符合生理、方便术后观察等优点,已成为目前治疗恶性胆道梗阻的重要方法之一,是一种安全有效的姑息性治疗手段.AIM： To explore the clinical effect of endoscopic metal biliary endoprosthesis （EMBE） combined with endoscopic nasobiliary drainage （ENBD） in the palliative treatment of malignant biliary obstruction. METHODS： The clinical data for 68 patients with malignant biliary obstruction who underwent endoscopic retrograde cholangiopancreatography （ERCP） for EMBE and ENBD from April 2010 to October 2012 were reviewed and analyzed. RESULTS： ERCP and biliary stent placement were successful in 64 of 68 cases, and the success rate was 94.12%. Jaundice obviously sub- sided in 95.31% of patients one week after stent placement. Postoperatively, liver function was improved significantly. There were 5 cases of complications, including hyperamylasemia in 3 cases, acute pancreatitis in 1 case and acute cholangitis in 1 case. Fifty-eight patients were followed postoperatively, and their average survival time was 10 mo ± 2.30 mo （3-26 mo）. The half-year, 1-year and 2-year survival rates were 67.24% （39/58）, 43.10% （25/58） and 5.17% （3/58）, respectively. The average stent patency time was 4 mo ± 2.26 mo （0-9 mo）. CONCLUSION： EMBE combined with ENBD can effectively relieve biliary obstruction and improve liver function in patients with malig- nant biliary obstruction, and is a safe and effective palliative treatment with less invasiveness and fewer complications.

关 键 词：内镜 胆道金属支架 鼻胆管引流 恶性胆 道梗阻 

分 类 号：R735[医药卫生—肿瘤]