内镜下胆道支架置入术治疗胰腺癌合并胆道梗阻25例

Endoscopic retrograde biliary drainage for 25 patients with biliary obstruction of pancreatic carcinoma

目的评估内镜下置入胆道金属支架对胰腺癌合并胆道梗阻患者姑息性治疗的疗效。方法收集苏北人民医院2013年1月1日-2013年12月31日临床确诊为胰腺癌合并胆道梗阻患者25例,均行ERCP术及置入胆管金属支架,比较手术前后血清总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（γ-GT）等指标变化情况,并随访3-6个月。结果该组ERCP胆道支架置入成功率为100%。胆道金属支架置入一周后,患者TBIL下降53.9%,DBIL下降61.0%,ALT下降60.2%,ALP下降36.8%,γ-GT下降57.1%,消除黄疸总有效率为92%,并发症发生率为12%,包括胆管炎、胰腺炎、高淀粉酶血症等,随访期间第48天有1例患者出现胆管支架阻塞,5例患者（第32天、44天、63天、72天、123天）由于肿瘤进展死亡。结论内镜下置入胆道金属支架对胰腺癌合并胆道梗阻创伤小,并发症发生率低,可持久引流胆汁,改善临床症状,显著提高患者生活质量,延长生存期,是一种安全、有效的治疗方法。

Objective To evaluate the effect of palliative therapy of biliary obstruction of pancreatic carcinoma by endoscopic placement of metal stent .Methods A total of 25 patients with biliary obstruction of pancreatic carcinoma were collected from Jan.2013 to Dec.2013 underwent insertion of metal stents endoscopically .The TBIL, DBIL, ALT, ALP,γ-GT were compared in preoperative and postoperative serum .We followed up all patients for 3-6 months.Re-sults Successful stent placement was achieved in all cases .After operation of 7 days, in plating gold biliary stent groups, the rates of descent of TBIL , DBIL, ALT, ALP,γ-GT were 53.9%, 61.0%, 60.2%, 36.8%and 57.1%, respectively .Jaundice was improved in 92%of serum bilirubin post-drainage complication rate was 12%.Complication included pancreatitis, cholangititis, 1 case of intrastent impaction occurred on the 48th day after endoscopic placement of metal stent.Five patients died of tumor progression at the 32th, 44th, 63th, 72th, 123th day, respectively.Conclu-sion Endoscopic placement of metal stent shows the following advantages： having little trauma and low complication rate, suitable for persistent biliary drainage , improving clinical symptoms and quality of life of the patients , prolonging lifespan.It is a secure and effective management for pancreatic carcinoma .