高位恶性胆道梗阻胆道双支架植入的疗效

Efficacy of Biliary Double Stents Implant on Malignant High Biliary Obstruction

目的分析胆道双支架植入联合胆道外引流治疗高位恶性胆道梗阻(malignant high biliary obstruction,MHBO)临床疗效及应用价值。方法 MHBO患者96例,胆道双支架植入联合胆道外引流77例、胆道单支架植入并对侧引流11例、单纯胆道外引流8例;观察术后近、远期疗效。结果胆道双支架植入联合胆道外引流77例,成功率为80.21%。96例MHBO患者术前总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶与术后第7、14天比较,差异有统计学意义(P<0.05);术后第21天胆道双支架植入患者总胆红素下降率(92.56%)明显高于胆道单支架植入并对侧引流和单纯胆道外引流患者(61.53%),差异有统计学意义(P<0.05)。77例胆道双支架植入患者3、6、9、12、15、18、21月生存率分别为98.70%、88.31%、76.62%、46.75%、18.18%、2.6%、1.3%。结论胆道双支架植入联合胆道外引流治疗MHBO是一种安全有效的方法,不仅能够迅速退黄并恢复肝功能,为肿瘤的进一步治疗赢取了时间,而且能提高患者的生存质量及延长生存期。

Objective To analyze the clinical efficacy and application of biliary double stents implant combined with biliary extra-drainage in the treatment of malignant high biliary obstruction(MHBO). Methods We retrospectively analyzed 96 MHBO patients, including 77 cases of biliary double stents combined with biliary extra-drainage, 11 cases of biliary single stent implant with contralateral drainage, and 8 cases of simple biliary extra-drainage. The short- and long-term curative effects were observed after operation. Results As for 77 cases of biliary double stents combined with biliary extra-drainage, its success rate was 80.21%. As for 96 MHBO patients, total bilirubin, TBIL, direct bilirubin, DBIL, alanine transaminase, ALT, aspartate transaminase and AST before operation were significantly different from those on the 7th, 14 th day after operation(P<0.05). Total bilirubin droop rate of patients with biliary double stents implant(92.56%) was obviously higher on postoperative 21 st day than those of patients with biliary single stent implant with contralateral drainage and with simple biliary extra-drainage(61.53%)(P<0.05). As for 77 patients with biliary double stents implant, the survival rates were 98.70%, 88.31%, 76.62%, 88.31%, 18.18%, 2.6%, 1.3% after 3, 6, 9, 12, 15, 18, 21 months, respectively. Conclusion Biliary double stents implant combined with biliary extradrainage is a safe and effective method to treat MHBO; it could not only quickly remove jaundice and recover liver function for further treatment of tumor, but also improve patients’ quality of life and extend the lifetime.