胆道塑料支架联合熊去氧胆酸治疗高龄危重胆总管巨大结石临床研究  

Clinical research of biliary plastic stenting combined with ursodeoxycholic acid in elderly patients with unextractable common bile duct stones

作　　者：王羊 张成 赵宝国 张瑞鹏[2] Wang Yang;Zhang Cheng;Zhao Baoguo(Department of Hepatobiliary Surgery, the Central Hospital of Xianyang,Shaanxi Province,Xianyang 712000)

机构地区：[1]陕西省咸阳市中心医院肝胆外科,咸阳712000 [2]陕西省人民医院血管外科,西安710068

出　　处：《陕西医学杂志》2018年第5期607-609,649,共4页Shaanxi Medical Journal

摘　　要：目的:探讨老年难取性胆总管结石患者治疗中胆道塑料支架置入联合熊去氧胆酸片治疗的安全性和有效性。方法:回顾性分析行胆道塑料支架置入治疗的老年性难取性胆总管结石患者103例的临床资料,先行常规逆行性胆胰管造影(ERCP)明确诊断,根据胆管扩张及结石大小情况,行十二指肠乳头括约肌切开后经导丝引导放置胆道塑料支架通畅引流,待胆道梗阻解除及胆管炎控制以后,随机分组,治疗组给予熊去氧胆酸片,每日600mg,分早晚2次口服;对照组未给任何口服溶石药物或安慰剂,入组病例均随访6~12月。结果:103例取石困难患者在常规ERCP后均成功置入塑料支架,1例高龄术后第2天死于心梗,1例并发急性重症胰腺炎不入组,1例十二指肠穿孔不入组,治疗组和对照组各50例;两组共有50例患者出现不同程度的腹痛及发热,给予对症治疗后好转,治疗组第2次行ERCP显示结石直径平均为(0.801±0.213)cm,有48例取出结石,取石成功率48/50(96%),未取出之结石再次放置塑料支架;对照组第2次行ERCP显示结石直径平均为(1.571±0.621)cm,有20例取出结石,取石成功率20/50(40%),未取出之结石再次放置塑料支架,两组比较差异均有统计学意义(P<0.05)。结论:对于老年性难取性胆管结石患者,塑料支架内引流联合熊去氧胆酸片治疗是一种十分有效和相对安全的治疗方式。Objective:To investigate the clinical application value of Biliary Plastic Stenting combined with ursodeoxycholic acid in elderly patients with unextractable common bile duct stones.Methods:103 elderly patients with Large Common Bile Duct Stones were underwent plastic biliary stenting were retrospectively analyzed,all the patients were underwent endoscopic retrograde cholangiopancreatography(ERCP)to confirm the diagnosis preferentially,103 elderly patients with unextractable common bile duct stones were placed Biliary Plastic Stenting,103 cases were divided into two groups,ursodeoxycholic acid group and control group after biliary obstruction relief and inflammation control;ursodeoxycholic acid group were treated with ursodeoxycholic acid 600mg each time,twich a day,control group were did nothing,all the cases were followed up 6-12monthes.Results:103 patients were successfully placed biliary stents,one case died after the operation because of Myocardial infarction,one case complicated severe pancreatitis,one case happened intestinal perforation,the three cases were not divided into anny grope;50 cases occurred abdominal pain and fever,cured after symptomatic trertment.The mean common bile ductstone size was(0.801±0.213)cm for the second ERCP in the theatment group,and 48 cases were removed completely in the theatment group,The success rate was 96%,17 cases continued to be observed by Biliary Plastic Stenting since the difficulties for taking stone;The mean common bile duct stone size was(1.571±0.621)cm for the second ERCP in the control group,and 20cases were removed completely in the control group,The success rate was 40%,30 cases continued to be observed by Biliary Plastic Stenting since the difficulties for taking stone,the difference was significant(P<0.05).Conclusion:Biliary Plastic Stenting combined with ursodeoxycholic acid is an ideal treatment for elderly patients with unextractable common bile duct stones.

关 键 词：胆总管结石 支架 胰胆管造影术 内窥镜逆行 牛磺熊去氧胆酸 老年人 

分 类 号：R657.42[医药卫生—外科学]