自膨式金属支架置入术在晚期胆道恶性梗阻治疗中的应用

Application of self-expanding metal rack in malignant biliary obstruction

目的 探讨自膨式金属支架置入术治疗晚期胆道恶性梗阻的安全性和应用价值.方法 28例晚期胆道恶性梗阻患者通过逆行胰胆管造影放置胆道金属支架,治疗前及治疗后7d检查患者肝功能,并观察治疗成功率、并发症发生情况及治疗后生存时间.结果 28例患者中,26例成功放置自膨式金属支架,成功率92.9％.治疗后患者肝功能明显改善,总胆红素[（213±42） μmol/L比（81±35） μmol/L]、直接胆红素[（ 146±38） μ mol/L比（56±32） μmol/L]、丙氨酸转氨酶[（135±64） U/L比（55±43） U/L]、天冬氨酸转氨酶[（ 130±58） U/L比（53±40） U/L]、谷氨酰转移酶[（590±135）U/L比（301±110） U/L]、碱性磷酸酶[（608±127） U/L比（337±104） U/L]均较治疗前降低,差异均有统计学意义（P＜0.05）.治疗后,1例发生急性胰腺炎,1例发生急性胆管炎,1例发生支架再堵塞,并发症总发生率11.5％.胆道通畅中位时间8.6个月,中位生存时间10.8个月.结论 自膨式金属支架置入术治疗晚期胆道恶性梗阻具有较高的安全性和成功率,并发症发生率低,对缓解患者症状、延长患者生存时间有较大帮助.

Objective To study the safety and application value of biliary tract metal rack treating advanced stage malignant obstruction of biliary tract.Methods From July 2006 to August 2010,28 patients with advanced stage malignant obstruction of biliary tract were treated with biliary tract metal rack by endoscopic retrograde cholangiopancreatography （ERCP）.Liver function pretherapy and posttherapy was tested for 7 days.Achievement ratio,effective ratio,neopathy and live time were also observed.Results Among 28 patients,26 had biliary tract metal rack by ERCP successfully and the success ratio was 92.9%.After treatment,liver function was improved significandy.Before and after treatment,the difference of total bilirubin [ （213 ± 42）μmol/L vs （81 ± 35 ）μmol/L],serum bilirubin[ （ 146 ±38） μmol/L vs（56 ±32） μmol/L],ALT [ （ 135 ±64）U/L vs （55 ±43）U/L],AST[ （ 130 ± 58 ） U/L vs （53 ± 40 ） U/L ],glutamyltransferase [ （ 590 ± 135 ） U/L vs （ 301 ± 110 ） U/L ],alkaline phosphatase [ （608 ± 127 ） U/L vs （337 ± 104） U/L ] were statistically significant （ P 〈 0.05 ）.One patient had acute pancreatitis.One patient had cholangitis.One patient had obstruct of metal rack and the incidence rate was 11.5%.Meso time of metal rack unobstruction was 8.6 months.Meso live time was 10.8 months.Conclusions Biliary tract metal rack has high safety and achievement ratio treating advanced stage malignant obstruction of biliary tract with a low neopathy.Biliary tract metal rack can release symptom and elevate survival rate.