胰管支架治疗伴有胰管扩张的中晚期胰腺癌疼痛的临床对照研究  

Controlled clinical study on pancreatic stenting in the relief of pain of advanced pancreatic cancer with dilated pancreatic duct

作　　者：高飞[1] 麻树人[1] 张宁[1] 张迎春[1] 赵云峰[1] 艾美娜[1] 宫照杰[1] 刘宝军[2] 

机构地区：[1]沈阳军区总医院内窥镜科,110016 [2]沈阳军区总医院医务部,110016

出　　处：《中华消化杂志》2013年第12期853-856,共4页Chinese Journal of Digestion

基　　金：辽宁省博士科研启动基金（20101131）;沈阳军区总医院科研基金（09Y-Z02）

摘　　要：目的探讨胰管内引流术缓解伴有胰管扩张的中晚期胰腺癌患者腹痛的疗效。方法伴有胰管扩张的中晚期胰腺癌患者61例分为2组，支架组30例（支架植入失败而剔除2例），采用内镜逆行胰胆管造影术、胆管支架内引流和胰管支架内引流术；对照组31例，采用内镜逆行胰胆管造影术和单纯胆管支架内引流术。观察术前后血淀粉酶，记录疼痛视觉模拟评分法（VAS）评分、疼痛缓解率、生存时间和并发症情况。组间率的比较采用卡方检验，组间计量资料比较采用t检验，组内VAS评分的比较采用单因素方差分析。结果支架组和对照组术后1d血淀粉酶分别为（62．65±27．31）U／L和（76．17±21．64）U／L，两组差异无统计学意义（t=0．07，P〉0．05）。支架组术后3个月VAS评分（3．99±1．13）较术前（6．53±1．87）明显降低（F=0．535，P〈0．05），支架组术后疼痛缓解率（59．09％）明显高于对照组（26．09％），差异有统计学意义（x2=19．06，P〈0．05）。支架组和对照组的中位生存期分别为8．66个月和8．40个月，差异无统计学意义（t=0．11，P〉0．05）。两组均未观察到严重并发症的发生。结论胰管支架可以减轻伴有胰管扩张的中晚期胰腺癌患者疼痛，但不延长生存期。Objective To explore the efficacy of pancreatic stenting in the relief of abdominal pain of advanced pancreatic cancer with dilated pancreatic duct. Methods A tolal of 61 patients with advanced pancreatic carcinoma companied with dilated pancreatic duct were divided into two groups. Twenty eight cases （two cases were excluded because of stent loss） in stent group treated with endoscopic retrograde cholangiopanereatography （ERCP）, endoscopic biliary stenting and pancreatic stenting; 31 cases in the control group treated with ERCP and endoscopic biliary stenting. Before and after stenting, the blood amylzyme, visual analog scale（VAS） score, pain remission rate, survival time and complications were observed. X2 test was performed for rate comparison between groups; t-test was used for measurement data comparison between groups and ANVOA was for VAS score comparison intra-group. Results One day after operation, the serum amylzyme level of stent group and control group was （62.65±27.31） U/L and （76.17±21.64） U/L, respectively. There was no statistically significant difference between two groups （t = 0. 07, P 〈 0. 05）. Three months after operation, VAS score of stent group （3.99±1. 13） significantly decreased compared with that before operation （6.53＋ 1.87, F=0.535,P〈0.05）. After operation, the pain remission rate of stent group （59.09%） was obviously higher than that of control group （26. 09%）, and the difference was statistically significant （Zz 19.06, P〈0.05）. The median survival time of stent group and control group was 8.66 months and 8. 40 months, respectively, and there was no significant difference （t= 0.11, P〈0.05）. No severe complication occurred in both groups. Conclusion Endoscopic pancreatic stenting can relieve pain of advanced pancreatic cancer patients with dilated pancreatic duct, however can not prolong their survival time.

关 键 词：胰腺肿癌 胰胆管造影术 内窥镜逆行 支架 疼痛 

分 类 号：R735.9[医药卫生—肿瘤]