高位恶性胆道梗阻介入手术入路与并发症的对比分析

Comparative analysis of interventional procedures and complications of high malignant biliary obstruction

目的分析右侧入路单通道及双侧入路双通道胆道双支架植入内引流在高位恶性胆道梗阻(malignant high biliary obstruction,MHBO)中的应用价值。方法MHBO患者141例,其中数字减影血管造影(digital subtraction angiography,DSA)下经右侧右胆管穿刺建立右侧单工作通道后,行胆道双支架植入内引流,即右侧入路单通道胆道双支架植入(简称右侧单通道胆道双支架植入)组(A组)103例,DSA下分别穿刺左、右胆管建立双工作通道后,行胆道双支架植入内引流,即双侧入路双通道胆道双支架植入(简称双侧双通道胆道双支架植入)组(B组)38例;分析及比较不同介入手术入路的近期并发症与疗效。结果 2组患者术前总胆红素值比较,差异无统计学意义(P>0.05);2组患者术后第21天总胆红素水平均较术前明显下降,但术后2组比较差异无统计学意义(P>0.05)。A组患者胆道出血、胆汁漏、胆心反射、穿刺点疼痛、引流管脱落发生率明显少于B组,差异有统计学意义(P<0.05);2组患者胆道感染、引流管渗液发生率差异无统计学意义(P>0.05);2组患者均未发生胸膜损伤、肝脓肿、胰腺炎。结论右侧单通胆道双支架植入技术简化了操作步骤,减少了操作创伤及并发症,是治疗MHBO安全有效的方法,具有明显的临床实际应用价值。

Objective To analyze the application value of right single channel and bilateral double channel of biliary double stents implant combine with biliary extra-drainage in treating malignant high biliary obstruction(MHBO).Methods One hundred and forty-one patients of MHBO,including 103 patients with digital subtraction angiography guiding,punctured on the right side of right billiary,established right single channel,implanted biliary double stents with biliary internal drainage,namely the right side of single channel of biliary double stents implant(right side single biliary double stent implantation,group A),and 38 cases are punctured on the right and left billiary,establish bilateral double channel,implanted biliary double stents with biliary internal drainage,namely bilateral double channel of biliary double stents implant(double channel double biliary stent implantation,group B).The different complications and short term curative effects of 2 groups were analyzed and compared.Results Twenty-first days after operation,the total bilirubin levels of the patients in the 2groups were significantly lower than those before the operation.However,there was no significant difference between the 2groups after operation(P>0.05).The incidence rate of hemobilia,bile leakage,biliary cardiac reflex,puncture point pain,drainage tube slip in group A is lower than that in group B,and the difference is significant(P<0.05).There was no significant difference between the 2groups in the incidence of biliary infection and drainage tube(P>0.05).Two groups of patients had no pleural injury,liver abscess,pancreatitis.There was no significant difference on the total bilirubin between the 2groups before and after the operation at twenty-first days(P>0.05).Conclusion The technique of single side biliary double stents is a safe and effective method for the treatment of MHBO,and has obvious clinical application value.