观察开腹与内镜下胆道支架置入治疗晚期恶性梗阻性黄疸的效果

分析观察开腹与内镜下胆道支架置入治疗晚期恶性梗阻性黄疸的效果。方法:选取我院2019年2月~2020年11月收治的晚期恶性梗阻性黄疸患者138例作为回顾性分析,患者根据不同置入手术方式分为两组,A组采取开腹置入治疗,B组实施内镜下胆道支架置入治疗,对比两组患者治疗后肝功能变化水平。结果:根据研究,两组患者均完成胆管末端支架置入手术治疗,置入后胆红素在术后一周均有所下降。手术第二周胆红素依然处于下降趋势,A组患者术后血清胆红素、血清ALT、AST、ALP以及GT均低于B组,两组两组患者上述肝功能指标对比具有差异,P〈0.05表示统计学有意义。分析两组患者手术前后肝功能变化,患者手术后第一周和第二周的血清胆红素、ALT、AST、ALP和GT以及术后第二周的血清白蛋白均低于手术前,第二周的胆红素指标低于术后第一周,手术前后各项指标对比具有差异表示统计学有意义(P〈0.05)。分析患者术后并发症发病率,A组患者出现1例轻度胆管炎、1例轻度胰腺炎、1例胆道出血;B组患者术后出现1例轻度胆管炎、1例轻度胰腺炎和2例胆道出血,两组患者术后并发症对比无差异,则不具有统计学意义。胆管炎的主要临床症状为右上腹疼痛,轻度反跳痛,通过抗生素有明显好转。胰腺炎症状表现为轻度腹痛、腹胀、伴随血尿淀粉酶升高,通过胃肠道减压、抗炎、营养支持等进行处理症状得到好转。结论:胆道支架常用的置入手段为开腹置入和内镜下置入两种方式,这两种手段都具有改善恶性梗阻性黄疸患者的的胆道梗阻情况,促进肝功能的恢复,促进患者机体康复,提高患者的生活质量。临床治疗中,需要根据患者的实际情况选择合适的置入方式,制定针对性的手术治疗方案,提高胆道支架置入手术的安全性和有效性。

Comparison of treatment outcomes between biliary plastic stent placements with and without endoscopic sphincterotomy for inoperable malignant common bile duct obstruction

AIM:Considerable controversy surrounds the adoption of endoscopic sphincterotomy(ES)to facilitate the placement of 10F plastic stents(PS)and to reduce the risk of pancreatitis The aim of the study was to assess the possible advantages of ES before PS placement. METHODS:From 3/1996 to 6/2001,172 consecutive patients, who underwent placement of a single 10F-polyethylene stent for inoperable malignant strictures of the common bile duct,were randomly assigned to 2 groups.In group A(96 patients),a ES was performed before PS placement In Group B,96 patients had PS directly.Early complications(within 30 d)and late effects(from 30 d to stent replacement)were assessed.Patency interval was defined as the period between PS placement and obstruction or death.The success of stent replacement in the 2 groups was evaluated. RESULTS:Stent insertion was successful in 95.8%(92/96) of the pts in group A and in 93.7%(90/96)of the patients in group B(P>0.05).Early complications were more frequent in patients who underwent ES(6.5% vs4.4%)but the data were not significant(P>0.05).In group A pancreatitis developed in two patients and bleeding in three;whereas pancreatitis occurred in 2 patients in group B.Complications were managed conservatively.No procedure related mortality occurred.All late complications were acute cholangitis due to stent occlusion.We performed a stent replacement in 87 patients that was successful in 84 cases without differences between groups. CONCLUSION:Sphincterotomy does not seem to be necessary for placement of 10F-PS in patients with malignant common bile duct obstruction.