鼻胆引流管经内镜剪断后残端用于治疗胆管癌相关恶性胆管梗阻60例

Clinical research of endoscopic cutting and indwelling nasobiliary drainage tube used for cholangiocarcinoma-related malignant biliary obstruction

目的探讨经内镜剪断并留置鼻胆引流管用于治疗恶性胆管狭窄的临床疗效及安全性。方法纳入2016年1月至2018年2月在遂宁市第一人民医院住院的因晚期胆管癌所致恶性胆管狭窄的患者114例,根据治疗方法分为鼻胆引流管剪断留置组(剪断留置组)(n=60)及支架组(n=54),所有患者均在ERCP下使用鼻胆管外置引流,待胆汁引流清澈后,剪断留置组直接在内镜下剪断并留置部分鼻胆管在胆道内,而支架组在取出鼻胆管后再行ERCP植入塑料支架。观察两组患者治疗相关指标,常规随访观察近远期疗效及安全性。结果与支架组相比,剪断留置组治疗操作时间及治疗费用显著降低(P<0.05)。支架组中2例(3.7%)患者在取出鼻胆管后因ERCP时导丝插入困难需要再次切开十二指肠乳头。所有患者生存时间为3~9个月,剪断留置组术后生存时间与对照组差异无统计学意义。剪断留置组中,1例(1.7%)发生胆管炎;支架组中,1例(1.8%)同时发生胆道出血及胆管炎,1例(1.8%)发生胆管炎,3例(5.6%)出现了支架移位(经内镜取出)。随访至4周时,剪断留置组与支架组相比,在总胆红素(TBIL)、直接胆红素(DBIL)、总胆汁酸(TBA)及瘙痒评分方面差异无统计学意义。随访至12周时,剪断留置组TBIL、DBIL及TBA均显著低于支架组,差异有统计学意义(P<0.05)。结论经内镜剪断并留置鼻胆引流管用于治疗胆管癌相关恶性胆道梗阻具有较植入塑料支架更好的效果,可作为患者姑息治疗及改善生活质量的候选方法。

Objective To investigate the clinical efficacy and safety of endoscopic cutting and indwelling nasobiliary drainage tube for cholangiocarcinoma-related malignant biliary obstruction.Methods A total of 114 patients with advanced cholangiocarcinoma-related malignant biliary obstruction from January 2016 to February 2018 were enrolled.All patients were divided into nasobiliary drainage tube cut-indwell group(cut-indwell group)(n=60)and plastic stent group(n=54).Nasobiliary drainage tube was used for extenal drainage in all patients until the jaundice was improved significantly.The nasobiliary drainage duct was directly cutted and indwelled in the biliary tract under the endoscope in cut-indwell group,and nasobiliary drainage tube was taken out and the plastic stent was implanted in plastic stent group.All the patinets were followed up.Results Compared with plastic stent group,the operation time and cost in cut-indwell group were significantly decreased(P<0.05).Two(3.7%)patients in the plastic stent group were required re-incision the duodenal papilla due to difficulty in guiding insertion during ERCP after removing the nasobiliary drainage duct.The survival time of all patients was 3-9 months,and there was no significant difference of postoperative survival time between cut-indwell group and plastic stent group.In cut-indwell group,1(1.7%)developed cholangitis.In plastic stent group,1(1.8%)developed biliary hemorrhage and cholangitis,1(1.8%)developed cholangitis,and 3(5.6%)developed plastic stent displacement(solved by endoscopic removal).After 4 weeks,there were no significant differences in TBIL,DBIL,TBA and pruritus score between cut-indwell group and stent group.After 12 weeks,TBIL,DBIL and TBA in cut-indwell group were significantly lower than those in plastic stent group.Conclusion The clinical efficacy and safety of endoscopic nasobiliary drainage tube cutted and indwelled for cholangiocarcinoma-related malignant biliary obstruction is superior to the plastic stent,which it can be used as a candidate palliative treatment.