经内镜胆道支架选择方式对恶性胆总管梗阻的疗效分析

Endoscopic-guided biliary drainage:stenting selection for malignant common bile duct obstruction

目的观察各胆道支架选择方式对不同病因恶性胆总管梗阻的疗效、术后并发症及治疗费用。方法选择2010年7月至2015年12月在我院肝胆外科因恶性胆总管梗阻行ERCP术置入胆道支架治疗的47例患者作为研究对象,按照置入胆道支架的不同,所有病例分为金属支架组(A组,n=16)、单塑料支架组(B组,n=17)和多塑料支架组(C组,n=14),观察三组患者支架通畅时间、并发症及手术相关费用。结果对于胰腺癌型,A组和C组的平均支架通畅时间明显比B组长(P<0.05),且A组优于C组,但差异无统计学意义(P>0.05);对于胆管癌型和壶腹周围癌型,A组和C组的平均支架通畅时间明显比B组长,差异有统计学意义(P<0.05);其中C组优于A组,但差异无统计学意义(P>0.05)。结论针对不同病因的恶性胆总管梗阻患者,选择个性化胆道支架治疗方案,既提高治疗效果,减少并发症,又降低医疗费用,为患者的后续治疗节省成本。

Objective To observe the effect,postoperative complications and treatment costs of different bile duct stent selection on malignant common bile duct obstruction and investigate the optimal treatment. Methods Forty-seven consecutive patients with malignant bile duct obstruction underwent endoscopic biliary stenting by ERCP surgery in the Hepatobiliary Surgery of our hospital from July2010 to December 2015. Of all patients,16 were treated by metal stent(group A),17 had single plastic stent(group B)and 14 had multiple plastic stent(group C). The patency duration,complications and operation cost were recorded and compared between three groups. Results For the patients with pancreatic cancer,the mean stenting patency durations of group A and group C were significantly longer than of group B,but there was no significant difference between group A and group C. For cholangiocarcinoma and periampullary carcinoma patients,the mean stenting patency durations of group A and group C were significantly longer than of group B,and group C was slightly better than the group A but the difference was not statistically significant. Conclusion As regard to the patients with malignant common bile duct obstruction,endoscopic biliary stenting should follow the individualized treatment option program for the purpose of improving treatment effect,reducing complications and costs.