单通道双国产胆道支架在恶性高位梗阻性黄疸的临床应用

The clinical application of single channel and double Chinese - made biliary stent in high biliary malig- nant obstructive jaundice

目的：探讨肝门部恶性梗阻性黄疸单侧穿刺单通道双胆道国产支架引流的疗效、安全性。方法回顾性分析哈尔滨医科大学附属肿瘤医院2012年10月—2013年12月收治24例肝门部高位恶性梗阻性黄疸患者临床资料，每例患者均接受双国产胆道支架治疗。其中采用单通道双支架治疗9例（试验组），采用双侧通道双支架15例（对照组）；比较两组的术中穿刺肝管次数、辐射曝露剂量、操作时间、引流有效率及并发症发生率。结果试验组穿刺肝管平均1．44±0．53次，明显低于对照组3．73±0．70次，差异有统计学意义（ P＜0．01）。试验组透视下操作时间、辐射曝露剂量平均为（1152．22±335．61）s、（653．22±207．02）mGy，略低于对照组（1236．93±463．43）s、（727．00±348．52）mGy，差异无统计学意义（P＜0．05）。4周后复查肝功，试验组与对照组引流有效率分别为88．9％（8／9）、86．7％（13／15），差异无统计学意义（P＝1．00）。试验组有1例胆汁渗出，对照组有2例胆道出血，两组均无严重并发症发生。结论单通道双国产胆道支架减黄治疗损伤小、疗效确切，可选择性应用于治疗肝门区梗阻性黄疸患者。

Objective To discussion the efficacy and safety of single channel and double chinese -made biliary stent in high biliary malignant hilar obstructive jaundice .Methods We reviewed the clinical data of 24 malignant hilar obstructive jaundice patients treated with single channel and double chinese -made biliary stent from October 2012 to December 2013 retrospectively.Of which 9 cases（study group）were used for single channel and double stenttreatment,and 15 cases（control group）were treated by the bilateral channel;We compared the number of intraoperative percutaneous puncture hepatic duct , radiation exposure doses , operation time , drainage effectiveness and complication rates in the two groups .Results The average number of percutaneous puncture hepatic duct in the study group was 1.44 ±0.53 times,which was significantly lower than the control group （3.73 ±0.70 times）.The fluoroscopy time and radiation exposure dose of study group was 1152.22 ±335.61 s and 653.22 ±207.02 mGy,which was slightly less than the control group （1236.93 ±463.43 s and 727.00 ±348.52 mGy）,the difference was not statistically significant （P=0.638;P=0.572）.Liver function was tested after 4 W, the drainage effectiveness of study group and the control group were 88.9%（eight-nineths）,86.7%（thirteen-fifteenths）,the difference was not statistically significant .One case occurred bile leakage in the study group ,2 pa-tients with hemobilia in control group ,both groups showed no serious complication .Conclusion The single chan-nel and double chinese -made biliary stent to treat high biliary malignant hilar obstructive jaundice is minimally injured and effective ,which can be selectively applied to treat patients with hepatic hilum malignant obstructive jaundice .