内镜逆行胰胆管造影胆道支架置入引流治疗不可切除恶性胆道狭窄的效果观察

Effect of biliary stent implantation and drainage under endoscopic retrograde cholangiopancreatography in the treatment of unresectable malignant biliary stricture

目的探讨内镜逆行胰胆管造影胆道支架置入引流治疗不可切除恶性胆道狭窄(MBS)的临床效果,以期对完善治疗方案起到指导作用。方法回顾性抽取2017年5月至2022年5月新乡医学院第一附属医院收治的不可切除MBS患者97例,依据治疗方案分为研究组(48例)与对照组(49例)。对照组行经皮肝穿刺胆道引流术(PTCD),研究组行内镜逆行胰胆管造影胆道支架置入引流。比较两组手术指标、康复指标、并发症、肝功能指标。结果研究组术中出血量少于对照组(P<0.05)。研究组住院时间、黄疸消退时间、腹痛消退时间短于对照组(P<0.05)。术后1周,研究组血清直接胆红素、天冬氨酸转氨酶、总胆红素水平低于对照组(P<0.05)。研究组并发症发生率(6.25%,3/48)低于对照组(20.41%,10/49),差异有统计学意义(P<0.05)。结论内镜逆行胰胆管造影胆道支架置入引流治疗不可切除MBS效果明显,可改善手术指标,缩短康复进程,改善肝功能,手术安全性较好。

Objective To investigate the effect of biliary stent implantation and drainage under endoscopic retrograde cholangiopancreatography in the treatment of unresectable malignant biliary stricture(MBS),in order to guide the improvement of treatment plan.Methods A total of 97 patients with unresectable MBS admitted to the First Affiliated Hospital of Xinxiang Medical University from May 2017 to May 2022 were retrospectively selected.And the patients were divided into study group(48 cases)and control group(49 cases)according to treatment regimen.The control group underwent percutaneous transhepatic cholangial drainage(PTCD),while the study group underwent biliary stent placement and drainage under endoscopic retrograde cholangcreatography.The surgical indicators,rehabilitation indicators,complications and liver function indicators of the two groups were compared.Results The study group had less intraoperative bleeding compared with the control group(P<0.05).The study group had shorter hospital stay,jaundice resolution time,and abdominal pain resolution time compared with the control group(P<0.05).One week after surgery,the study group had lower levels of serum direct bilirubin,aspartate transaminase and total bilirubin compared with the control group(P<0.05).The incidence of complications in the study group(6.25%,3/48)was significantly lower than that in the control group(20.41%,10/49),P<0.05.Conclusions Biliary stent implantation and drainage under endoscopic retrograde cholangioangiography has a remarkable effect in the treatment of unresectable MBS,which can improve surgical indicators,shorten rehabilitation process,and improve liver function,with good surgical safety.