经内镜胆道支架置入术对恶性肿瘤致梗阻性黄疸疗效观察

Curative effects of endoscopic biliary stent implantation on malignant tumor induced obstructive jaundice

目的 探讨经内镜胆道支架置入对恶性肿瘤致胆道梗阻的疗效。方法 回顾性分析本院2008年12月~2013年6月共99例逆行胰胆管造影（ERCP）内镜下胆道支架置入治疗胆道恶性肿瘤导致的梗阻性黄疸患者临床资料,分析术前联合影像学检查诊断正确率、手术成功率、并发症发生率及术后1 w血清总胆红素和碱性磷酸酶的变化。结果 术前影像学诊断正确率为67.7%,误诊率为22.3%;梗阻部位位于胆总管下段、中段及上段患者分别有42例（42.4%）、23例（23.2%）及34例（34.3%）;其中并发胆管结石23例（23.2%）,胆管化脓性感染15例（15.1%）;术中与术后并发症包括出血、高淀粉酶血症、胆管炎,总发生率为8.1%。与术前相比,术后1 w血清总胆红素、碱性磷酸酶及γ-谷氨酰转移酶均显著降低（P〈0.01）。结论ERCP内镜下胆道支架置入是胆道肿瘤致梗阻性黄疸安全的治疗方法 ,具有较好疗效,可考虑在临床中推广运用,以延长患者生存时间,提高生活质量。

Objective To discuss the curative effects of endoscopic biliary stent implantation on malignant tumor induced obstruction of biliary tract. Methods A retrospective analysis was performed to analyze the clinical data of 99 patients with malignant induced biliary obstruction between December 2008 and June 2013, who were treated with biliary stent implantation through endoscopic retrograde cholangiopancreatography （ERCP）. Analysis was also made in the preoperative imaging diagnostic accuracy, success rate, the incidence of complications, changes in serum total bilirubin, and alkaline phosphatase 1 week after the treatment. Results The preoperative imaging diagnostic accuracy was 67.7%. Misdiagnosis rate was 22.3%. There were 42 （42.4%）, 23 （23.2%）, and 34 patients （34.3%） patients with the obstruction located in the under, middle, and upper segment, respectively. Among those, there were 23 patients（23.2%） complicated with bile duct stones, and 15 ones（15.1%） with biliary tract pyogenic infection. The intraoperative and postoperative complications included bleeding, hyperamylasemia, cholangitis, and the overall incidence was 8.1%. Compared with the data before the surgery, the serum total bilirubin, alkaline phosphatase, and γ- gtutamyltransferase all significantly decreased one week after the surgery （P〈 0.01）. Conclusion The ERCP endoscopic biliary stenting is a safe treatment for obstructive jaundice caused by biliary tract tumor, which has good curative effects and can be promoted in clinic in order to prolong the patients＇ survival time and improve their quality of life.