内镜下胆管引流术治疗恶性胆道梗阻

Endoscopic biliary drainage for the treatment of malignant biliary obstruction

目的探讨经内镜逆行胰胆管造影术(ERCP)加鼻胆管引流(ENBD)、塑料支架置入引流(ERBD)或金属支架置入引流(EMBE)治疗恶性胆道梗阻的疗效比较。方法 136例恶性胆道梗阻患者,分为:ENBD组、ERBD组和EMBE组,观察各组疗效、支架通畅时间及生存时间。结果三组总体置管成功率95.4%;治疗1周内肝功能及临床症状较术前明显好转,引流总体有效率为91.0%;并发症发生率为5.4%。ERBD组平均通畅时间(88.0±21.9)d,EMBE组平均通畅时间(200.6±46.6)d,两组差异有统计学意义(P<0.0 1);ERBD组平均生存时间(215.4±111.3)d,EMBE组平均生存时间(271.8±100.8)d,两组差异无统计学意义(P>0.05)。结论经ERCP对恶性胆道梗阻患者给予鼻胆管引流及支架置入是一种安全有效的姑息性治疗方法。

Objective To explore the clinical value and therapeutic effect of andoscopic nasobiliarydrainage （ENBD）, endoscopic retrograde biliary drainage （ERBD） and endoscopic metal biliary endoprosthesis （EMBE） via endoscopic retrograde cholangiopancreatography （ERCP） on malignant biliary obstruction. Methods One hundred and thirty-six patients with malignant biliary obstruction underwent ENBD, ERBD or EMBE according to the patients＇ conditions and the therapeutic effect, stent mean patency duration and mean survival time were observed. Results The successful rate of procedure was 95.4%. Within a week after endoscopic procedure, patients＇ liver function and clinical symptoms were significantly improved and drainage satisfaction rate was 91.0%. Post-drainage complication rate was 5.4%. The mean patency duration of ERBD and EMBE was （88.0 ± 21.9） d and （200.6 ± 46.6） d respectively, there was significant difference between them （P〈0.01）. The mean survival time of ERBD and EMBE was （215.4 ± 111.3） d and （271.8 ± 100.8） d respectively, there was no significant difference between them （P〉0.05）. Conclusion The measure of biliary stent insertion and ENBD via ERCP for malignant biliary obstruction is a safe and effective treatment.