介入治疗恶性梗阻性黄疸的疗效及并发症分析

ANALYSIS OF THERAPEUTIC EFFECT AND COMPLICATIONS OF INTERVENTIONAL THERAPY FOR MALIGNANT OBSTRUCTIVE JAUNDICE

目的:探讨恶性梗阻性黄疸胆道支架置入的临床疗效及并发症的发病原因及相应的处理方法。方法:我院2009-01~2011-01的80例恶性梗阻性黄疸病人,经逆行胰胆管造影并胆道支架置入术进行介入治疗。术前术后检测血常规、TBil、DBil、GGT(γ-谷氨酰转移酶)、血清中糖抗原19-9(CA 19-9)。记录临床症状的变化及并发症,术后常规随访,观察各种并发症的发生情况并给予针对性的处理。结果:病人1次支架置入成功数为74例(92.5%)。有4例病人行2次支架置入成功,2例失败。病人的黄疸消失时间(6.1±1.5)d,皮肤瘙痒消失时间(3.0±0.3)d。术后5例并发胆道出血,未有病人出现感染。治疗后血清总胆红素、GGT、CA 19-9均呈下降趋势,病人在治疗前后的血清总胆红素、GGT、CA 19-9差异有统计学意义(P<0.05),治疗后3d和1wk的血清总胆红素值显著低。治疗后随访6mo^2a,平均(12.4±6.3)mo,半年内死亡29例,半a至1a死亡7例,1a至1a半死亡10例,1a半至2a死亡5例。其余29例病人随访至今均存活。有2例病人出现胆管炎,并发症发生率为2.3%。未有病人出现气胸、导管脱位、胆汁性腹膜炎等并发症。结论:ERCP并胆道支架置入术治疗恶性梗阻性黄疸,可明显延长恶性梗阻性黄疸病人的生存时间,是一种相对合理的选择。通过对各种并发症的发生原因进行分析,积极防治并发症,可提高病人的生存时间,改善其生命质量。

Objective：To discuss clinical efficacy of biliary stent placement in the treatment of malignant obstructive jaundice, and the causes of the complications and relative treatment method. Methods：80 cases of malignant obstructive jaundice patients in our hospital from 2009 January to 2011 January were treated with endoscopic retrograde cholangiopancreatography and biliary stent for interventional therapy,in addition to anti-infection,hemostasis and symptomatic treatment. Preoperative and postoperative blood routine, TBil, DBil, GGT （ gamma glutamyl transferase ） , serum carbohydrate antigen 19-9（CA 19-9）,GGT（gamma glutamyl transferase）were measured. The changes of clinical symptoms and complications were recorded, various complications were observed and given targeted treatment. Results：74 patients had successful stent implantation at one times（92. 5%）. There were 4patients with 2 stents and successfully treated and 2 patients failed. The jaundice disappearance time was（ 6. 1＆#177;1. 5 ） d, skin itching disappeared time was （ 3. 0＆#177;0. 3 ） d. After operation 5 cases had complications with biliary tract bleeding,no infection occurred in patients. After treatment,serum total bilirubin,GGT,CA 19-9 were decreased,with statistical significance（P＆lt;0. 05）. Serum total bilirubin after 3 d and 1 weeks of the treatment were significantly lower. Follow-up time was 6months to 2 years, the averaged time was（12. 4＆#177;6. 3）months. 29 patients died within six months,half a year with 1 years, 7 cases with half to 1 years,10 cases with 1 and 1. 5 years,5 cases with 1. 5 to 2 years. The rest of the patients were followed-up and survived. 2 cases had cholangitis,and the accurance rate of complication was 2. 3%. Pneumothorax, catheter dislocation and bile peritonitis were observed in no of these patients. Conclusion：ERCP combined with biliary stent for malignant obstructive jaundice can obviously prolong the survival of patients with malignant obstructive jaundice, and it is a relatively reasonable choice. Analysis of complications causes,active prevention of complications can improve the survival time of patients,and improve their quality of life.