内镜下支架置入对肝门部胆管癌的治疗评价

Endoscopic stent placement for hilar cholangiocarcinoma

目的探讨内镜下支架置入术对肝门部胆管癌患者的治疗效果,并对单侧塑料支架与双侧塑料支架置入进行回顾性分析。方法回顾性分析2014年1月至2017年1月在新疆军区总医院行内镜下逆行胰胆管造影(endoscopic retrograde cholangio pancreatography,ERCP)支架置入术的70例肝门部胆管癌(hillar cholangiocarcinoma,HCCA)患者。其中63例成功置入支架,测定成功置入支架患者术前与术后的总胆红素(Tbil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)进行比较。纳入研究的70例HCCA患者中,Ⅲ型和Ⅳ型共有60例,均置入塑料支架,按照塑料支架置入数量的不同分为:单塑料支架组33例、双塑料支架组27例,比较两组支架的置入成功率,并将两组成功置入支架的53例HCCA患者分为单侧支架组(A组)31例、双侧支架组(B组)22例,比较A、B两组减黄有效率、术后并发症的发生率、支架中位通畅期及患者中位生存期。结果63例患者术后肝功能各项指标均较术前明显下降(P<0.05);单侧支架置入组支架置入成功率与双侧支架相比无差异(93.9%vs81.5%,P>0.05);A、B两组引流有效率无明显差异(58.1%vs72.7%,P>0.05);B组术后总体并发症发生率为54.5%,高于A组的25.8%(P<0.05),其中胆道感染的发生率为31.8%,显著高于A组的6.5%(P<0.05);B组中位通畅期及中位生存期高于A组,但相比均无明显差异(P>0.05)。结论内镜下支架置入术短期内能明显改善患者肝功能延长生存期;单侧塑料支架相比双侧塑料支架置入可获得同样的胆管引流效果。

Objective To investigate the therapeutic effect of endoscopic stent placement in patients with hilar cholangiocar-cinoma,and to retrospectively analyze the effect of unilateral and bilateral plastic stents placement. Methods A retrospective analysis was made of 70 patients with hilar cholangiocarcinoma (HCCA) who underwent endoscopic retrograde cholangio pancreatography (ERCP) stenting in Xinjiang Military Region General Hospital from January2014 to January2017. Among them, 63 patients were successfully implanted stent. Total bilirubin (Tbil)、alanine aminotransferase (ALT)、aspartate aminotransferase (AST), glutamyl transpeptadase (GGT) and alkaline phosphatase (ALP) were measured in 63 patients before operation and after operation.Then compare the preoperative and postoperative values. Among the 70 HCCA patients included in the study, 60 cases of type III and type IV were implanted with plastic stents. According to the number of plastic stents, they were divided into33 cases in single plastic stent group and27 cases in double plastic stent group. The success rates of stent implantation in the two groups were compared.Fifty-three HCCA patients with type III and type IV who were successfully implanted stents were divided into unilateral stent group (group A)31 cases and bilateral stent group (group B)22 cases. Compare the effective rate of reducing jaundice, the incidence of complications, the median patency period of stent and the median survival period of patients between the two groups. Results The indexes of liver function in 63 patients after operation were significantly lower than those before operation ( P <0.05). There was no difference in the success rate of stent implantation between unilateral stent group and bilateral stent group(93.9% vs 81.5%, P >0.05);There was no significant difference in drainage efficiency between groups A and B(58.1% vs 72.7%, P >0.05);The overall incidence of complications in group B was 54.5%, which was higher than that in group A25.8%( P <0.05),and the incidence of cholangitis was31.8%, which was significantly higher than that in group A 6.5%( P <0.05);The median patency period and median survival period in group B were higher than those in group A, but there was no significant difference( P >0.05). Conclusion Endoscopic stent implantation can significantly improve the liver function and prolong the survival time in a short time. Unilateral plastic stent placement can achieve the same biliary drainage effect as bilateral plastic stent placement.