ERCP放置胆道内支架行姑息性胆道引流术治疗低位恶性梗阻性黄疸的临床疗效分析  

Analysis of clinical efficacy of ERCP biliary stent implantation for palliative biliary drainage in the treatment of low-grade malignant obstructive jaundice

作　　者：梁勇 母齐鸣 万波 贺伟 王刚 LIANG Yong;MU Qi-ming;WAN Bo(Department of Hepatobiliary and Pancreatic Surgery,363 Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]三六三医院肝胆胰外科,成都610041

出　　处：《肝胆外科杂志》2019年第5期348-351,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探究经内镜胰胆管造影(ERCP)支架植入胆道引流术应用于姑息性治疗低位恶性梗阻性黄疸的临床效果.方法对134例低位恶性梗阻性黄疸患者临床资料进行回顾性分析,行ERCP支架植入胆道引流术者纳入ERCP组(n=58),行经皮肝穿刺胆管引流术(PTCD)联合支架植入者纳入PTCD组(n=76).比较术前及术后3d时,两组肝功能指标[总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)],分析两组围术期基本指标、近期并发症及总生存期差异.结果术后3d时,两组血清TBil、DBil、ALT水平均较术前有显著下降(P<0.05),但组间同一时间比较均无统计学意义(P>0.05).两组手术成功率比较无统计学意义(P>0.05),而ERCP组住院时间、治疗费用均明显少于PTCD组(P<0.05).两组出血、胆瘘、十二指肠穿孔、急性胰腺炎发生率比较均无统计学意义(P>0.05),而ERCP组感染、电解质紊乱、支架移位/堵塞发生率明显低于PTCD组(P<0.05).两组中位总生存期比较无统计学意义(P>0.05).结论ERCP支架植入胆道引流术治疗低位恶性梗阻性黄疸效果较突出,且相较于PTCD联合支架植入方案安全性更为理想,对加快患者术后康复有利.Objective To explore the clinical effects of endoscopic retrograde cholangiopancreatography(ERCP)stent implantation for biliary drainage in the palliative treatment of low-grade malignant obstructive jaundice.Methods The clinical data of 134 patients with low-grade malignant obstructive jaundice were retrospectively analyzed.Patients with ERCP stent implantation for for biliary drainage were included in ERCP group(n=58),and patients with percutaneous transhepaticcholangial drainage(PTCD)combined with stent implantation were included in PTCD group(n=76).The liver function indexes[total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT)]were compared in the two groups before surgery and at 3d after surgery.The perioperative basic indexes,recent complications and overall survival time were analyzed in the two groups.Results At 3d after operation,the serum levels of TBil,DBil and ALT in the two groups were significantly lower than those before operation(P<0.05),but there were no significant differences between the two groups at the same time(P>0.05).There was no significant difference in the success rate of surgery between the two groups(P>0.05),and the hospital stay and treatment cost in ERCP group were significantly less than those in PTCD group(P<0.05).There were no significant differences in the incidence rates of hemorrhage,biliary fistula,duodenal perforation and acute pancreatitis between the two groups(P>0.05),and the incidence rates of infection,electrolyte disorder and stent displacement/congestion in ERCP group were significantly lower than those in PTCD group(P<0.05).There was no significant difference in the median overall survival time between the two groups(P>0.05).Conclusion ERCP stent implantation for biliary drainage has prominent effects in the treatment of low-grade malignant obstructive jaundice,and it has more ideal safety than PTCD combined with stent implantation,and it is beneficial to accelerate postoperative rehabilitation of patients.

关 键 词：经内镜胰胆管造影 支架 姑息性胆道引流术 低位恶性梗阻性黄疸 经皮肝穿刺胆管引流术 

分 类 号：R657.4[医药卫生—外科学]