经内镜胆管内支架置入术对恶性胆管梗阻的临床应用

ENDOSCOPIC RETROGRADE BILIARY DRAINAGE IN MANAGEMENT OF MALIGNANT BILE DUCT OBSTRUCT

目的探讨经内镜胆管内支架置入术对各种恶性胆管梗阻的治疗效果。方法66例恶性胆管梗阻病人先行内镜逆行胰胆管造影(ERCP)检查,确定胆管梗阻病变部位和性质后,再决定使用内镜下塑料胆道支架引流(ERBD)和内镜下金属胆道支架引流(EMBE)。结果66例患者中64例插管成功,成功率96.97%(64/66)。行ERBD 44例,行EMBE 20例,主要见于胰头癌、胆管癌、壶腹癌、原发性肝癌及肝门及肝内转移压迫胆管,所有病例均在引流后总胆红素及直接胆红素明显下降。结论经内镜下胆管内支架引流术的应用愈来愈广泛,其操作安全而有效,特别是对各种恶性病变引起的胆管梗阻起了关键性的治疗作用。

Objective To evaluate the effects of endoscopic retrograde biliary drainage （ERBD）in management of malignant bile duct obstruction. Methods 66 patients with malignant biliary obstruct were firstly examined with ERCP （ Endoscopic Retrograde Cholangiopancreatography） to make a definite diagnosis of the location and character of the biliary obstruct, and then appropriate biliary drainage was chosen ERBD （ endoscopic retrograde biliary drainage） or EMBE （ endoscopic metal biliary endoprothesis）. Results 64 cases of 66 were successfully embedded with biliary stents, the successful rate of biliary sent placement was 96. 97 % （64/66）. 64 cases with malignant biliary stenosis were drainaged ERBD（44 cases）and EMBE （20 cases）respectively. The main cause was carcinoma of head of pancreas, cholangiocarcinoma, ampullar carcinoma, primary hepatic carcinoma and metastatic hepatic cancer extruding biliary duct inside the liver. The total and direct bilirubin of all the patients dropped significantly after endoscopic retrograde biliary drainage. Conclusion Endoscopic retrograde biliary drainage had definite therapeutic effect for various malignant biliary stenosis. Its clinical applicability became more widespread due to its safety and efficient results.