良、恶性胰胆管梗阻经内镜内置管引流临床研究

Clinical analysis of endoscopic stent placement for drainage of patients with cholangiopancreatic duct obstruction

目的分析胰胆管内支架引流疗效,探讨影响因素与提高疗效手段。方法回顾性分析治疗随访资料。结果 1995-02/1999-03采用塑料、金属胆道支架,塑料胰管支架经内镜主乳头置入胰胆管引流良恶性胰胆管梗阻148例,其中男83例,女65例,平均57.1岁。塑料胆道支架组:成功率94.7％,良、恶性梗阻引流有效率分别为89.3％与79.3％(P<0.05)。金属胆道支架与塑料胰管支架组:成功率与有效率均为100％。术后早期并发症包括:高淀粉酶血症,轻度ERCP术后胰腺炎、术后早期胆管炎,无严重相关并发症与相关死亡发生。结论胰胆管梗阻内置管引流术是一种安全有效的治疗手段,合理选择病例,采用不同手段力求导丝通过狭窄、双支架引流等方法可改善疗效。

AIM To evaluate the clinical effect of stent for cholangiopancreatic duct obstruction and discuss the factors to improve its effect. METHODS Review of follow-up data. RESULTS A total of 148 cases were placed with stent from February 1995 to March 1999. The average age of the patients was 57.1 years, 83 were male and 65 female. In the plastic biliary duct stent group: the effective rate of draining for benign biliary obstruction was 89.3%, and malignant biliary obstruction was 79.3% (P<0.05). The success rate was 94.7%. In the metal biliary stent and plastic pancreatic stent group, the success rate and effective rate were both 100%. Early complication included mild post-ERCP pancreatitis, cholangititis and hyperamylasemia. Occlusion of stent was the major late complication.CONCLUSION Endoscopic stent placement for patients with cholangiopancrentic duct obstruction is safe and effective. Choosing case reasonably, making great efforts to make the quide wire over the stricture lesion and placing double stent can improve the therapeutic effect.