胆道支架覆盖十二指肠乳头与否疗效比较  

Comparison of the Effect of Biliary Stent Covering the Duodenal Papilla or Not

作　　者：钱雪峰 赵震宇 QIAN Xue-feng;ZHAO Zhen-yu(Department of Radiology,Kunshan Hospital of Traditional Chinese Medicine,Kunshan,Jiangsu,215300,China)

机构地区：[1]江苏省昆山市中医医院放射科,江苏昆山215300

出　　处：《中国血液流变学杂志》2020年第4期486-488,515,共4页Chinese Journal of Hemorheology

摘　　要：目的对比胆总管恶性梗阻治疗中金属裸支架放置覆盖与不覆盖十二指肠乳头部的差异.方法2014年8月—2020年8月胆总管恶性梗阻患者接受支架植入治疗96例,分为2组,A组50例以自膨式金属裸支架覆盖乳头部放置,B组46例未覆盖乳头.比较两组患者临床好转(总胆红素消退)、生存时间、支架通畅时间等.结果两组术前胆红素水平分别为(255±110)mmol/L、(290±118)mmol/L(P=0.127),总胆红素平均消退率术后1周分别为(55.7±16.6)%、(61.1±13.7)%,术后1个月分别为(84.2±5.7)%、(86.2±5.7)%,差异均无统计学意义(P=0.083、0.082);并发胆道出血A组9例(18.0%),B组7例(15.2%),差异无统计学意义(P=0.715);术后胆道感染A组12例(24.0%),高于B组4例(8.7%)(P=0.044).两组支架平均通畅时间分别为(307.8±20.2)d、(490.7±40.8)d,B组较长(P=0.023).两组平均存活时间分别为(245.1±17.4)d、(286.3±20.2)d,组间差异无统计学意义(P=0.074).结论支架放置不覆盖十二指肠乳头部感染率低、通畅时间长.如病变未侵及乳头部,支架不宜跨过十二指肠乳头部放置.Objective To compare the difference in the treatment of malignant common bile duct obstruction with bare metal stents covering and not covering the duodenal papilla.Methods From August 2014 to August 2020,96 patients with malignant obstruction of the common bile duct received stent implantation and were divided into 2 groups.50 cases in group A were placed on the nipple with a self-expanding bare metal stent,and 46 cases in group B.The nipples are not covered.Patients’clinical improvement(total bilirubin regression rate),survival time,stent patency time,etc.were compared.Results The preoperative bilirubin levels of the two groups were(255±110)mmol/L and(290±118)mmol/L(P=0.127),one week after operation,the total bilirubin regression rate were(55.7±16.6)%and(61.1±13.7)%,one month after the operation,they were(84.2±5.7)% and(86.2±5.7)%,and there was no significant difference(P=0.083,0.082);9 cases(18.0%)in group A with biliary hemorrhage,7 cases in group B(15.2%),no significant difference(P=0.715);12 cases(24.0%)of postoperative biliary tract infection in group A,were higher than 4 cases in group B(8.7%)(P=0.044).The average patency time of the two groups of stents were(307.8±20.2)d and(490.7±40.8)d,and group B was longer(P=0.023).The average survival time of the two groups were(245.1±17.4)d and(286.3±20.2)d,and there was no significant difference between the two groups(P=0.074).Conclusion Stent placement without covering the duodenal papilla has a low infection rate and a long patency time.If the lesion does not invade the nipple,the stent should not be placed across the duodenal papilla.

关 键 词：恶性胆管梗阻 金属支架 十二指肠乳头 胆红素 

分 类 号：R816[医药卫生—放射医学] R657.43[医药卫生—临床医学]