内镜下胆道支架置入术在高位胆管恶性梗阻中的临床总结

Endoscopic biliary stent implantation in patients with malignant hilar biliary obstruction

目的探讨经内镜放置胆道支架治疗高位胆管恶性梗阻的疗效及影响因素。方法回顾性分析2008年8月~2014年4月168例高位胆管恶性梗阻行内镜胆道支架置入术的成功率、有效引流率、并发症发生率与30天死亡率、支架通畅时间及生存时间。结果168例患者中148例成功通过ERCP置入塑料或金属支架,其中13例联合PTCD途径反向导丝与ERCP对接的会师技术置入,成功率88.1%;另外20例行两种处理方法仍未能成功,改行PTCD外引流;有效引流率为91.9%,早期并发症发生率为23.0%,总的支架有效时间59天,总的中位生存时间248天。结论高位胆管恶性梗阻的内镜治疗应根据个体化原则选择不同的治疗方案;内镜治疗过程中进行有效的操作,减少并发症,是临床内镜医生应重视的问题。

Objective The aim of this study is to discuss the efficacy of biliary stent implantation under endoscopy in malignant biliary hilar obstruction and its influencing factors.Methods We evaluated the success rate,effective drainage rate,the incidence of complications,30 d mortality rate,duration of unobstructed stent and survival time for 168 cases who underwent biliary stent implantation under endoscopy from Aug.2008 to Apr.2014,who were retrospectively analyzed.Results In 168 cases, 148 were successfully implanted with plastic or metal stents through endoscopic retrograde cholangiopancreatography(ERCP),among them,13 were performed under a reunion operation which combines percutaneous transhepatic cholangio(PTC)and ERCP,and the success rate was 88.1%;another 20 cases failed in both and were converted to PTCD external drainage;the effective drainage rate was 91.9%,the incidence of early complications was 23.0%,the total effective time of stents was 59 days,and median survival time was 248 days.Conclusion These pilot results indicate that different treatment protocols should be chosen according to individualized principle;and clinical doctors should pay attention to effective operation and the reduction of complications.