不同途径胆道支架置入治疗恶性梗阻性黄疸42例回顾分析

Retrospective Review of Bile Duct Stent Insertion with Different Pathway in Treatment of Malignant Biliary Obstruction with 42 Cases

目的探讨不同方式胆道支架置入在恶性梗阻性黄疸患者临床治疗中的应用价值及选择。方法回顾分析42例不能根治切除的恶性梗阻性黄疸患者采用记忆金属合金胆道内撑支架经开腹手术置入(n=18)、经PTCD置入(n=17)及经ERCP置入(n=7)治疗的情况。结果所有患者均完成胆管末端支架置入达到内引流。支架植入术后胆红素均在术后第1周下降约100μmol/L;谷草转氨酶、谷丙转氨酶、碱性磷酸酶及谷氨酰转肽酶在术后第1周开始较术前明显下降(P<0.05)。全组中位生存时间为22周,平均生存(32.89±33.87)周。全组围手术期死亡2例,死亡率为4.76%。主要并发症有胆管炎8例,胆道出血3例,肝功能衰竭2例。结论胆道支架经开腹手术置入、经PTCD置入及经ERCP置入均可有效解除恶性梗阻性黄疸患者胆管梗阻,改善肝功能;临床应根据患者的局部及全身情况选择不同的置入方式,提高安全性及有效性,尽可能减少并发症的发生。

Objective To discuss the value of biliary stent in treatment of malignant biliary obstruction with different pathways of bile duct stent insertion. Methods Fourty-two cases of malignant biliary obstruction whose biliary stent insertions were through operation （n = 18）, PTCD （n = 17） and ERCP （n= 7） respectively were reviewed retrospectively. Results The bile duct stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion （P〈0.05）. The median survival time was 22 weeks. The average survival time was （32.89±33.87） weeks. Two patients died in hospital after PTCD, and the mortality was 4.76 %. Complications included 8 cases of cholangitis, 3 cases of bile duct hemorrhage and 2 cases of hepatic failure. Conclusion The bile duct stent insertions through operation, PTCD and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to decrease the occurrence of complications.