内镜下胆道内支架置入治疗恶性梗阻性黄疸58例疗效分析

Analysis of 58 Cases of Malignant Biliary Obstruction Treated by Endoscopic Biliary Stent Insertion

目的:探讨经十二指肠镜行胆道支架置入术以及鼻胆管引流治疗恶性梗阻性黄疸的疗效。方法:58例恶性梗阻性黄疸的患者,均行ERCP(经内镜逆行胰胆管造影)术,根据情况置入不同支架或行鼻胆管引流术,观察其疗效和3个月、6个月生存率。结果:56例病人插管成功,插管成功率97%。其中36例置入金属支架。18例置入塑料支架,2例行单纯鼻胆管引流,2例未能插管成功而放弃ERCP。并发症5例,其中急性胰腺炎2例,高淀粉酶血症2例,急性胆管炎1例,并发症率8.9%。插管成功的56名患者血清胆红素从(377.4±155.5)μmol/L下降到术后1周(146.4±54.5)μmol/L(P<0.01),支架组随访40例中总体3个月、6个月存活率分别达到94%及77%。结论:通过ERCP所进行的支架的放置术以及鼻胆管引流是姑息治疗恶性梗阻性黄疸的有效方法。

Objective： To investigate the clinical value and therapeutic effect of ENBD, EBMSD and ERBD via encoscopic retrograde cholangio-pancreatography （ ERCP） on malignant obstructive jaundice. Methods： A retrospective review of 58 patients with malignant obstructive jaundice （37 men and 21 women with an average age of 61 years old） receiving ERCP. Different biliary stents or ENBD were placed according to the patient＇s conditions. Outcomes were followed after three and six months. Results： ERCP were successful in 56 cases of all the 58 cases, and 36 were suecessfully embedded with self-expandable metal stents, 18 cases were embedded with plastic stents. The other two cases were only treated with ENBD. Five cases had complications, but none of them had sequela after correct treament. The serum level of total bilirubin decreased from （377.4±155.5）μmol/Lto （146. 4±54. 5）μmol/L after treatment （P〈0.01）. The follow up in vestigation in 40 patients （70%） indicated that the survival rates of 3 months and 6 months after the treatment were 94% and 77% respectively. Conclusion： These results indicate that biliary stent insertion and ENBD via ERCP is an effective and safe palliative treatment for malignant bile duct obstruction.