恶性梗阻性黄疸内镜下逆行胰胆管造影引流术后疗效观察

Clinical observation of malignant obstructive jaundice after ERCP drainage

目的 探讨恶性梗阻性黄疸经内镜下逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）引流术后的疗效.方法 60例恶性肿瘤引起的梗阻性黄疸患者,通过ERCP术置入胆管支架,观察插管成功率、肝功能变化及并发症发生情况.结果 60例患者中57例插管成功,成功率为95.0％ （57/60）.57例插管成功的患者中9例胆管内放置金属支架,2例行单纯鼻胆管引流,3例行塑料内支架＋鼻胆管引流,其余43例行8.5～ 10F塑料内支架引流术.术后患者黄疸及皮肤瘙痒等表现减轻或消失.术后1周,患者丙氨酸转移酶（ALT）、天冬氨酸转移酶（AST）、血清总胆红素（TBIL）、直接胆红素（DBIL）、碱性磷酸酶（ALP）、r-谷氨酰基转移酶（GGT）均显著降低（P＜0.05）.9例行胆管金属支架置入的患者中,1例于术后5个月发生支架阻塞,行胆泥清理并置入塑料支架后金属支架引流通畅.1例单纯鼻胆管引流患者20 d后获得外科手术治疗机会,另1例经鼻胆管引流1个月后肝功能恢复正常,得以行外科根治性手术治疗,43例行胆管塑料支架置入的患者中,8例于术后1～4周出现TBIL水平再次上升,行ERCP检查明确为支架移位或阻塞,给予更换支架,其中有1例更换为金属支架,3例置入塑料双支架.结论 通过ERCP术放置胆管引流治疗恶性梗阻性黄疸,对于患者黄疸等症状的改善及生存质量的提高具有确切疗效.

Objective To investigate the effects of malignant obstructive jaundice after endoscopic retrograde cholangiopancreatography （ERCP） drainage.Methods Sixty patients with obstructive jaundice due to advanced carcinoma were treated with biliary stent through ERCP.The successful rate of biliary stent placement,changes of liver function and complications were detected.Results Fifty-seven cases were successfully embedded with biliary stents,the successful rate of biliary stent placement was 95.0％ （57/60）.Nine cases were embedded with self-expandable metal stents （EMS）,2 cases sembedded with naso-biliary,3 cases sembedded with naso-biliary and plastic stent,43 cases embedded with plastic stents.The serum ALT,AST,TBIL,DBIL,ALP,GGT were significantly dereased after endoscopic therapy （P ＜ 0.05）.Biliary stent occlusion occurred in 1 patient embedded with EMS after 5 months,then they were cleaned up the bile mud and placed with plastic stents into previous stents.One patient with naso-biliary drainage 20days achieved the opportunity of surgical treatment in the future.The other patient＇ s liver function returned to normal after 1 month of nose biliary drainage and received radical surgery.The total serum bilirubin was increased in 8 cases embedded with plastic stent after 1 ～ 6 weeks,because the stents were displaced and blocked.The stents were replaced and metal stents were replaced for one case of them,dual stents were placed for three cases of them.Conclusion Biliary drainage through EPCP could effectively relieve symptoms of jaundice and improve the life quality for patients with unresectable biliary obstruction caused by malignant neoplasm.