内镜下胆汁内引流术治疗胰头癌胆道梗阻的临床研究

Clinical application of endoscopic retrograde billiary drainage for obstruction of biliary tract caused by carcinoma of head of pancreas

目的评价内镜下胆汁内引流术（ERBD）治疗胰头癌胆道梗阻的临床疗效。方法46例胰头癌胆道梗阻患者进行ERBD治疗（塑料支架或金属支架）。结果46例患者置入支架39例成功。术后患者血清总胆红素（104．67±15．49）斗moL／L较术前（371．37±49．23）斗moL／L明显降低（P〈0．01），肝功能改善[ALT：术前（210．34±27．25）U／L，术后（196．57±19．29）U／L；AST：术前（178．69±19．79）U／L，术后（167．58±18．97）U／L；r—GT：术前（326．12±25．96）U／L，术后（198．43±20．86）U／L；ALP：术前（489．77±45．67）U／L，术后（298．56±28．49）U／L，P均〈0．051。术后塑料支架阻塞11例，阻塞平均时间162d；金属支架阻塞4例，阻塞时间平均213d。术后患者6个月生存率71．8％，12个月生存率46．2％。结论ERBD可明显改善胰头癌并胆道梗阻患者的症状，提高患者生活质量，对于不能直接手术治疗或丧失根治机会的晚期患者是较好的姑息性治疗手段。

Objective To evaluate the clinical efficacy of endoscopic retrograde billiary drainage （ERBD） for obstruction of biliary tract caused by carcinoma of head of pancreas. Methods Forty - six inpatients with biliary obstruction caused by carcinoma of head of pancreas were subjected to ERBD（ plastic or metal stent）and their clinical data were analyzed. Results Successful stent placement was performed in 39 cases of all. After ERBD,the serum total bilirubin of patients（ 104.67 ± 15.49）μmol/L was significantly decreased compared with that before ERBD （ 371.37 ±49.23 ） p, mol/L （ P 〈 0.01 ） and the liver function was improved [ before ERBD ： ALT（ 210.34 ± 27.25 ） U/L, AST （ 178.69 ± 19.79 ） U/L, r - GT （ 326.12 ± 25.96 ） U/L, ALP （ 489.77 ± 45.67 ） U/L）, after ERBD ： ALT （ 196.57 ± 19.29 ） U/L, AST （ 167.58 ± 18.97 ） U/L, r - GT （ 198.43 ± 20.86 ） U/L, ALP （ 298.56 ± 28.49 ） U/L ]. Occlusion of plastic stent occurred in 11 cases and the average time of occlusion were 162 days. Occlusion of metallic stent occurered in 4 cases and the average time of occlusion was 213 days. The survival rate for 6 months was 71.8% and 46.2% for one year. Conclusion ERBD may improve the conditions of patient with obstruction of biliary tract caused by carcinoma of head of pancreas. It is an alternative alleviative treatment for patients who cannot accept operation directly for carcinoma of head of pancreas or patients in terminal stage.