内镜引导下逆行胰胆管造影术胆道引流治疗恶性肝外胆道梗阻回顾性研究  

Endoscopic retrograde pancreatic angiography biliary drainage for the treatment of malignant extrahepatic biliary obstruction: retrospective analysis

作　　者：张昊[1] 李长锋[1] 马连君[1] 张斌[1] 

机构地区：[1]吉林大学中日联谊医院内镜中心,长春130033

出　　处：《中华胃肠内镜电子杂志》2015年第4期40-44,共5页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

摘　　要：目的 分析内镜引导下逆行胰胆管造影术（ERCP）胆道引流对恶性肝外胆道梗阻的姑息性治疗效果.方法 回顾分析吉林大学中日联谊医院内镜中心2012年4月至2014年5月纳入本研究的86例肝外胆道系统恶性梗阻患者的临床资料,其中男52例,女34例,年龄42～87岁[平均（67.8＆#177;11.4）岁].将86例患者分为三组：鼻胆管引流（ENBD）组46例、胆道塑料支架（ERBD）组36例、金属胆道支架（EMBE）组25例,分析三组患者引流效果、实施引流后1周内肝功能变化,比较长期引流支架通畅时间及生存时间.计量资料均以均数＆#177;标准差表示,胆道引流前后肝功变化资料采用配对t检验进行统计学分析;累计生存时间采用Kaplan-Meier法进行预估及制图,用Log-rank检验进行对比分析;支架通畅时间采用Kaplan-Meier法进行预估及制图,用非配对t检验进行统计分析,P ＜0.05为差异有统计学意义.结果 86例恶性肝外胆道梗阻患者共进行112次ERCP操作,其中成功插管及治疗107次,插管成功率95.5％ （107/112）,引流有效率为92.5％ （99/107）.对比内镜下胆道引流前后肝脏功能,ERBD组和EMBE组均有改善.ERBD和EMBE组的患者生存时间分别为（208.1 ＆#177;96.8）d和（274.1＆#177;98.5）d（P=8.167）,两组支架通畅时间分别为（83.9＆#177;36.4）d和（262.7 ＆#177;98.7）d（t =8.167,P＜0.001）.结论 ERCP胆道引流用于恶性胆道梗阻姑息治疗效果切实可靠,值得临床应用.Objective To analyzed the efficacy of endoscopic retrograde pancreatic angiography biliary drainage for the treatment of biliary obstruction in malignant extrahcpatic. Methods Eighty-six malignant extrahepatie biliary obstruction patients admitted in the Department of Endoscopic Center, China- Japan Friendship Hospital Affiliated to Jilin University from April 2012 to May 2014 were enrolled into this study and their clinical data were retrospectively analyzed including drainage satisfaction, changes of liver function before and after drainage, the stent pateney time and survival time in ERBD group and EMBE group. These 86 patients were divided into three groups, endoscopic nasobilialy drainage （ENBD） group, endoscopic retrograde biliary drainage （ERBD） group, and endoscopic metal biliary endoprosthesis （ EMBE ） group. Results Endoscopic retrograde cholangiopancreatography （ ERCP ） was operated 112 times, successful intubation and treatment were 107 times. The overall success rate of intubation 95.5% （107/112） and the total effective rate of 92.5% （99/107）. Compared with the liver function before andafter endoscopic biliary drainage, they were improved in both ERBD and EMBE groups （P 〈 0.05）. The average survival times of patients in ENBD and EMBE groups were （ 208. 1 ＋ 96.8 ） d and （ 274. 1 ＋ 98.5） d （P=8. 167）, and the patency times in these two groups were （83.9 _＋36.4） d and （262.7 ＋ 98.7） d （t = 8. 167, P 〈 0. 0001 ）. Conclusion ERCP biliary drainage for the palliative treatment of malignant biliary obstruction is practical and reliable and it is worth to the clinical application.

关 键 词：胆汁淤积 肝外 胆道梗阻 内镜下逆行胰胆管造影术 鼻胆引流管 胆道金属支架 胆道塑料支架 

分 类 号：R657.4[医药卫生—外科学]