胆胰管双支架治疗胰头癌患者的临床疗效观察  

Biliary-pancreatic double stents for pancreatic cancer with obstructive jaundice

作　　者：范震[1] 张筱凤[1] 张啸[1] 吕文[1] 郭英辉[1] 袁庆丰[1] 赵幼安[2] 

机构地区：[1]杭州市第一人民医院消化内科,310006 [2]山东大学齐鲁医院消化内科

出　　处：《中华消化内镜杂志》2013年第4期181-184,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的观察胆胰管双支架治疗胰头癌患者的临床疗效。方法2008年7月至2011年10月间，胰头癌患者按照每个月住院顺序的单、双数分为两组：32例单支架组患者放置胆管内支架，28例双支架组患者行胆、胰管双支架置入；观测患者放置支架前后肝功能指标以及疼痛、生活质量改善情况。结果60例胰头癌ERCP内镜治疗患者中，54例成功放置胆／胰管支架，成功率为90．0％。该54例患者血清总胆红素、肝功能指标较术前明显改善（P〈0．05）；症状减轻或消失；Kamofsky生活质量评分明显改善（P〈0．05）。两组疗效比较，双支架组患者总体疼痛缓解率以及完全缓解率明显高于单支架组，差异具有显著性意义（92．0％比55．2％；64．0％比34．5％，P均〈0．05）；术后14d，双支架组Karnofsky生活质量评分也明显优于单支架组[（85．5±13．1）比（56．9±16．4）]，差异有统计学意义（P〈0．05）。结论放置胆胰管双支架能明显改善胰头癌患者肝功能，改善胰管梗阻所致临床症状，在缓解疼痛和提高生活质量方面明显优于单纯放置胆管支架。Objective To analysis the clinical effects of biliary-pancreatic double stents in pancreatic cancer patients with obstructive jaundice. Methods From July 2008 to October 2011, a total of 60 patients with advanced pancreatic cancer were randomly divided into two groups to receive biliary-pancreatic double stents （ n = 28 ） or biliary stent only （ n = 32） according to the odd and even numbers of their admission date. Changes in liver function, abdominal pain, quality of life scores （QOL） were compared between two groups. Results The stents were placed successfully in 54 patients （90.0%） , in which symptoms were relieved or gradually disappeared in all patients after the procedure. One week after stents placement, the serum total bilirubin decreased significantly from 164. 32 ±45. 16 μmol/L before ERCP to 63.25 ±27. 06 μmol/L （P 〈 0.05 ）, other parameters including ALT, AST, AKP and r-GT were also decreased significantly compared with those of pre-ERCP （ P 〈 0. 01 ）, but there was no significant difference between the two groups （ P 〉 0. 05 ）. 25 cases in double-stents group and 29 cases in single-stent group had varying degrees of pain relief at 7d after ERCP, but the overall pain relief rate and complete pain relief rate in double-stent group were significantly higher than those in single-stent group （92. 0% vs. 55. 2%; 64. 0% vs. 34. 5%, P 〈 0.05 ）. At 7d and 14d after ERCP, Karnofsky QOL score were improved significantly in double-stent group （ P 〈 0. 05 ）. It was significantly better than single-stent group at 14d after ERCP （ P 〈 0. 05 ）. No death or other severe ERCP-related complications were observed. Conclusion Biliary-pancreatic stent placement for pancreatic cancer could significantly improve liver function and relieve obstructive pain. In the ways of alleviating pain and improving quality of life scores, it was better than ERCP biliary stent placement, especially for patients with pancreatic cancer combined obstructive pain. It indicated that bilia

关 键 词：胰腺癌 胰胆管造影术 内窥镜逆行 胆 胰管支架 

分 类 号：R735[医药卫生—肿瘤]