内镜治疗胰腺癌伴梗阻性黄疸疗效及成本分析

Efficacy and cost effectiveness analysis of endoscopic treatment for pancreatic cancer with obstructive jaundice

7目的探讨经口内镜置入塑料支架和金属支架治疗胰腺癌继发梗阻性黄疸的疗效及成本效益分析。方法回顾性分析2013年1月至2014年1月北部战区总医院收治的102例胰腺癌继发胆管梗阻患者的临床资料。根据内镜下放置胆管支架不同分为塑料支架组(26例)和金属支架组(76例),比较两组患者的并发症发生情况和近期疗效。随访记录患者生存期内胆管内支架治疗的次数、治疗间隔时间、每次住院治疗费用及中位生存时间。结果内镜治疗后5~7 d两组患者血丙氨酸转氨酶(ALT)和总胆红素(TBil)水平均明显低于治疗前,差异有统计学意义(P值均<0.05),但两组间的差异无统计学意义。两组均未发生严重并发症。金属支架组平均治疗次数较塑料支架组显著减少(1.7次比2.9次),治疗间隔时间较塑料支架组显著延长[(271.7±42.3)d比(113.4±38.2)d],两组间差异均有统计学意义(P值均<0.05);但两组平均总住院费用(84227.2元比86906.8元)、中位生存时间(15.6个月比13.1个月)的差异均无统计学意义。结论首次应用金属支架治疗胰腺癌继发胆管梗阻患者的成本效益优于塑料支架,且两者疗效相同。

Objective To investigate the therapeutic effect of endoscopic plastic stent and metal stent placement in relieving obstructive jaundice in patients with pancreatic cancer, and to analyse the cost effectiveness. Methods A retrospective review was performed on the clinical data of 102 pancreatic cancer patients with obstructive jaundice in General Hospital of Northern Theater Command between January 2013 to January 2014. The patients were divided into plastic stent group (n=26) and metal stent group (n=76) based on the type of biliary stent placed under endoscopy. The complication and short-term therapeutic effect were compared between two groups. The number of endoscopic stent placement, treatment interval, hospitalization cost and median survival time were recorded. Results The levels of alanine aminotransferase (ALT) and total bilirubin (TBiL) in the two groups 5-7 days after endotherapy were significantly lower than those before treatment, but the difference was not statistically significant between the two groups (P<0.05). No severe complication was observed. The average number of treatments in the metal stent group was significantly lower than that in the plastic stent group (1.7 times vs 2.9 times), and the treatment interval was significantly longer[(271.7±42.3)d vs (113.4±38.2)d]. The difference above between these two groups was statistically significant (P<0.05). However, there was no significant difference on the average total hospitalization cost (84227.2 yuan vs 86906.8 yuan) or median survival time (15.6 months vs 13.1 months) between these two groups. Conclusions Primary placement of metal biliary stents for obstructive jaundice in adult patients with metastatic pancreatic carcinoma was cost-effective than plastic stents, and their effects were comparable.