经内镜胆道支架置入术姑息性治疗恶性梗阻性黄疸的临床应用

Clinical application of endoscopic biliary stent insertion to treatment of malignant obstructive jaundice

目的 探讨经十二指肠镜放置胆道支架（EMBE、ERBD）和鼻胆管引流姑息治疗恶性梗阻性黄疸的有效性及临床应用价值.方法 回顾性分析2002年6月至2009年3月51例有绝对或相对手术禁忌证的恶性梗阻性黄疸病人成功行经内镜胆道支架置入术的有效率、并发症发生率、支架通畅时间及生存时间.结果 51例病人中,置入金属支架31例,置人塑料支架15例,2例单纯置入鼻胆管引流.其中黄疸指数下降48例,总胆红素从（279.6±143.7）μmol/L一周后下降到（125.7±78.3）μmol/L（P＜0.01）.出现急性胰腺炎并发腹痛者3例,高淀粉酶血症9例,发生胆绞痛者1例,贲门撕裂伴大出血1例,并发症发生率27.4%;支架通畅时间119 d;置入支架组随访39例,3个月、6个月生存率达到91%和74%.结论 通过十二指肠镜进行胆道支架置入和有效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 biliary stent insertion（EMBE, ERBD）and ENBD via endoscopic retrograde cholangio-pancreatography（ERCP）on malignant obstructive jaundice.Methods A retrospective review was conducted of 51 patients with malignant obstructive jaundice receiving ERCP in our hospital from June 2002 to March 2009.Different biliary stents or ENBD were placed into their biliary duct to drain bile.Meanwhile, the efective power, incidence rate, unobstructive time, and live time were determined.Results ERCP was successfully performed in all these 51 cases and 31 of them were successfully embedded with self-expandable metal stents while 15 of them had plastic stents.The last 2 cases were only treated with ENBD.Eleven cases had complications, but none of them had sequela after prompt treatment.In 48 cases, the serum level of total bilirubin decreased from（279.6±143.7）μmol/L to（125.7±78.3）μmol/L after drainage（P〈0.01）.The follow-up investigation in 39 cases indicated that the 3-and 6-month survival rates after the treatment were 91% and 74%, respectively.Conclusion Biliary stent insertion and ENBD via duodenoscopy is an effective and safe palliative treatment for malignant bile duct obstruction.