内镜逆行胰胆管造影术胆道引流在胆总管恶性肿瘤及肝门部胆管癌外科围术期中的应用

Application of ERCP-guided biliary drainage in perioperative period of common bile duct cancer and hilar cholangiocarcinoma

目的探讨内镜逆行胰胆管造影术(ERCP)胆道引流在胆总管恶性肿瘤及肝门部胆管癌外科围术期中的应用价值。方法选取2016年10月至2018年12月间山东省立第三医院收治的行ERCP术的88例肝门胆管癌患者,根据胆道引流方式不同分为内镜下鼻胆管引流术(ENBD)组(27例)、胆道塑料支架引流术(ERBD)组(35例)与胆道金属支架引流术(EMBE)组(26例)。比较各组患者的手术情况、肝功能指标、并发症发生情况以及生存率。结果所有患者共行ERCP术93次,插管成功率为94.6%(88/93),引流总成功率为92.0%(81/88)。ENBD组引流成功23例,失败4例,引流成功率为85.2%(23/27),ERBD组引流成功33例,失败2例,引流成功率为94.3%(33/35),EMBE组引流成功25例,失败1例,引流成功率为96.2%(25/26),三组比较,差异无统计学意义(P>0.05)。治疗后,三组患者的TBIL、DBIL、AST、ALT、GGT和ALP水平均较治疗前降低,差异均有统计学意义(均P<0.05)。有3例患者术后发生胆管炎,2例患者发生消化道出血,2例患者发生胆道感染,1例患者发生急性胰腺炎,1例患者发生胆漏,并发症总发生率为10.2%。2例行胆道支架引流患者术后出血腹痛,对症治疗后缓解。88例患者有5例患者失访,随访率为94.3%。随访时间为1年,共有38例患者死亡,其余45例患者于随访结束时仍生存。胆总管恶性肿瘤与肝门胆管癌患者ERCP术后的3个月生存率为88.0%,6个月生存率为68.7%,1年生存率为54.2%。结论ERCP胆道引流治疗胆总管恶性肿瘤和肝门部胆管癌手术成功率较高,术后并发症较少,结合不同的胆道引流术可以有效改善患者肝功能,延长生存时间。

Objective To evaluate the value of endoscopic retrograde cholangiopancreatography(ERCP)-guided biliary drainage in the perioperative period of common bile duct cancer and hilar cholangiocarcinoma.Methods Eighty-eight patients with hilar cholangiocarcinoma who underwent ERCP from October 2016 to December 2018 at The Third Hospital of Shandong Province were selected as the study subjects.According to the different ways of biliary drainage,they were divided into an endoscopic nasobiliary drainage(ENBD)group(27 patients),an endoscopic retrograde biliary drainage(ERBD)group(35 patients)and an endoscopic metal biliary endoprothesis(EMBE)group(26 patients).Surgery,liver function,complications and survival rate were compared between the two groups.Results ERCP was performed 93 times,the success rate was 94.6%(88/93)and the overall success rate was 92.0%(81/88).For ENBD group,the success rate was 85.2%(23/27),and the overall success rate was 94.3%(33/35).For EMBE group,the success rate was 96.2%(25/26).There was no significant difference in the success rate among the three groups(P>0.05).After the treatment,the levels of TBIL,DBIL,AST,ALT,GGT and ALP decreased significantly(all P<0.05).Cholecystitis occurred in 3 patients.Gastrointestinal bleeding occurred in 2 patients.Infection of biliary tract occurred in 2 patients.Pancreatitis occurred in 1 patient and bile leakage occurred in 1 patient.The overall incidence of postoperative complications was 10.2%.Bleeding and aabdominal pain occurred in 2 patients who underwent stents for drainage and recoved after the treatment.Five patints lost the follow-up.The follow-up rate was 94.3%.A total of 38 patients died over the follow-up of 1-year.The rest 45 patients were alive at the end of the follow-up.The 3-month,6-month and 1-year survival rate was 88.0%,68.7%and 54.2%,respectively.Conclusion ERCP-guided biliary drainage for biliary tumors and hilar cholangiocarcinoma has a high success rate and few complications.Combined with different biliary drainage,it can effectively improve the liver function and prolong the survival time of patients.