开腹旁路手术与内镜支架置入术在中晚期胰头癌患者治疗效果对比  

Comparison of open bypass surgery and endoscopic stenting in the treatment of patients with advanced pancreatic head cancer

作　　者：董磊 杨雨钊 王锋[2] DONG Lei;YANG Yuzhao;WANG Feng(Ningxia Medical University,Yinchuan 750004,China;Hepatobiliary Sugery Department,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院肝胆外科,宁夏银川750004

出　　处：《宁夏医学杂志》2022年第7期593-596,F0003,共5页Ningxia Medical Journal

基　　金：宁夏重点研发计划项目(2016KJHM60)。

摘　　要：目的比较分析中晚期胰头癌患者姑息治疗期间分别应用内镜下支架置入术与开腹旁路手术治疗的临床效果以及对生存时间的影响。方法选取收治的中晚期胰头癌患者资料进行回顾性分析,其中29例患者行姑息性旁路手术治疗(手术组),107例为内镜支架植入术治疗(支架组),比较2组患者术后并发症发生、进食时间、住院时长、住院总费用、疼痛程度、生活质量以及生存情况和血清生化指标。结果支架组患者血清胆红素、转氨酶水平术后3 d降低(P<0.05);2组患者住院费用和术后并发症比较差异无统计学意义(P>0.05);2组患者术后进食时间、住院时间比较差异有统计学意义(P<0.05);2组患者疼痛缓解率和术后第3天Karnofsky评分比较差异有统计学意义(P<0.05)。支架组和手术组中位生存期分别为149 d、193 d,2组累积生存率差异无统计学意义(P>0.05)。结论内镜支架置入术能够达到早期引流退黄效果,促进患者病情恢复,同时对患者造成的创伤较小。Objective To compare and analyze the efficacy and survival of the open bypass surgery and the endoscopic stenting in patients with advanced pancreatic head cancer during palliative treatment.Methods The date of advanced pancreatic head cancer patients who were treated with palliative treatment,including 107 cases of endoscopic stent implantation and 29 cases of palliative bypass surgery,was collected and retrospectively analyzed.The incidence of postoperative complications,postoperative eating time,length of hospitalization, total cost of hospitalization, degree of pain, quality of life, serum biochemical indexes was compared and observed between the two groups.Results The levels of serum bilirubin and transaminase in stent group decreased significantly three days after operation ( P <0.05). There was no significant difference in hospitalization expenses and postoperative complications between the two groups ( P >0.05). There were significant differences in postoperative eating time and length of hospitalization between the two groups ( P < 0.05 ). Compared with the operation group, the pain relief rate and Karnofsky score on the third day after operation in the stent group were significantly better ( P <0.05). The median survival time of stent group and operation group were 149 d and 193 d respectively. There was no significant difference in cumulative survival rate between the two groups ( P >0.05).Conclusion Endoscopic stent implantation can achieve the effect of early drainage and remove jaundice. At the same time, it can promote the recovery of patients faster without increasing the treatment cost. It has less trauma to patients, shorter postoperative fasting time, faster alleviate the symptoms of abdominal pain and improve the quality of life of patients. This operation is a safe and effective palliative treatment for patients with advanced pancreatic head cancer.

关 键 词：胰头癌 胆道支架 姑息性旁路手术 梗阻性黄疸 

分 类 号：R735.8[医药卫生—肿瘤]