猪尾型鼻胆引流管改制新型胆管塑料支架在肝门部胆管癌中的应用  

Application of a new plastic biliary stent modified based on pigtail nasal bile drainage tube to hilar biliary cholangiocarcinoma

作　　者：赵倩 洪丹丹 贾雯 王瑶 阚莹 徐璐 冀旭 曹阳 范宝军 麻树人 高峰 杨卓 Zhao Qian;Hong Dandan;Jia Wen;Wang Yao;Kan Ying;Xu Lu;Ji Xu;Cao Yang;Fan Baojun;Ma Shuren;Gao Feng;Yang Zhuo(Department of Endoscopy,General Hospital of Northern Theater Command,Shenyang 110000,China;Jinzhou Medical University,Jinzhou 121000,China)

机构地区：[1]中国人民解放军北部战区总医院内窥镜科,沈阳110000 [2]锦州医科大学,锦州121000

出　　处：《中华消化内镜杂志》2022年第6期435-440,共6页Chinese Journal of Digestive Endoscopy

基　　金：辽宁省科学技术计划(2019020042-JH2/103)。

摘　　要：目的比较猪尾型鼻胆引流管改制的新型胆管塑料支架与普通胆管塑料支架在姑息治疗肝门部胆管癌中的有效性和安全性。方法收集2018年6月—2020年12月于北部战区总医院内窥镜科因肝门部胆管癌导致的梗阻性黄疸行经内镜逆行胰胆管造影术姑息性治疗的38例患者资料,其中20例患者使用猪尾型鼻胆引流管改制支架(新型组),18例患者使用普通塑料支架(普通组)。随访至2021年5月30日,比较两组的操作时间、住院时间、术后胆管炎发生率、胆红素下降水平、支架通畅时间等指标。结果新型组和普通组的操作时间分别为(19.85±1.07)min和(22.00±3.38)min,差异无统计学意义(t=1.26,P=0.607)。新型组和普通组的住院时间分别为(11.45±2.39)d和(11.33±3.51)d,差异无统计学意义(t=-0.52,P=0.938)。新型支架与普通支架术后第5天较术前总胆红素降低幅度中位数分别为122.85μmol/L和96.25μmol/L,差异有统计学意义(Z=-2.03,P=0.042)。新型组远期胆管炎发生率低于普通组[10.0%(2/20)比44.4%(8/18)],差异有统计学意义(P=0.027)。新型组支架引流通畅时间高于普通组[(109.45±32.67)d比(82.11±20.95)d],差异有统计学意义(t=2.23,P=0.032)。结论相比普通胆管塑料支架,猪尾型鼻胆引流管改制的新型胆管塑料支架在姑息性治疗肝门部胆管梗阻时,可降低远期胆管炎发生率、延长胆管支架通畅期。Objective To compare the efficacy and safety of a new type of plastic biliary stent modified based on the pigtail nasobiliary duct and the common plastic biliary stent for hilar cholangiocarcinoma.Methods Data of a total of 38 patients with obstructive jaundice caused by hilar cholangiocarcinoma who received endoscopic retrograde cholangiopancreatography(ERCP)palliative treatment at the Endoscopy Center,General Hospital of Northern Theater Command from June 2018 to December 2020 were collected,including 20 cases using the new type of plastic biliary stent(the new stent group),and 18 cases using the common plastic stent(the common stent group).Patients were followed up to May 30,2021.The procedure time,hospital stay,postoperative biliary infection incidence,the bilirubin decrease,and the patency time of the stents in the two groups were compared.Results The procedure time was 19.85±1.07 minutes in the new stent group and 22.00±3.38 minutes in the common stent group,respectively,showing no significant difference between them(t=1.26,P=0.607).The lengths of hospital stay of the two groups were 11.45±2.39 days and 11.33±3.51 days,respectively,showing no significant difference between them(t=-0.52,P=0.938).The median margins of total bilirubin reduction in the two groups were 122.85μmol/L and 96.25μmol/L,respectively,with significant difference(Z=-2.03,P=0.042).The incidence of long-term cholangitis of the new stent group was significantly lower than that of the common stent group[10.0%(2/20)VS 44.4%(8/18),P=0.027].The patency time of the new stent group was significantly longer than that of the common stent group(109.45±32.67 days VS 82.11±20.95 days)with significant difference(t=2.23,P=0.032).Conclusion In the palliative treatment of hilar bile duct obstruction,the new plastic bile duct stent modified based on pigtail type can reduce the incidence of long-term cholangitis and prolong the patency of bile duct stent compared with the common stent group.

关 键 词：肝门胆管肿瘤 胰胆管造影术 内窥镜逆行 支架 引流 

分 类 号：R735.8[医药卫生—肿瘤]