经ERCP胆道金属支架植入治疗不可切除肝外胆道恶性梗阻的安全性及疗效评价

Evaluation of efficacy and safety of biliary metal stent implantation via ERCP in treatment of unresectable malignant extrahepatic biliary obstruction

摘要:

摘要：目的  探讨经内镜逆行胰胆管造影（ERCP）胆道金属支架置入对于肝外胆道恶性梗阻的临床疗效及安全性。方法 根据患者手术方法不同将40例恶性胆道梗阻患者分为经皮经肝胆管穿刺引流术（PTCD）组和ERCP组。PTCD组患者接受PTCD治疗，ERCP组患者接受ERCP置入金属支架治疗。结果 两组生存时间差异有统计学意义（P <0.05）。ERCP组术后胆道通畅时间明显长于PTCD组，差异有统计学意义（P <0.05）。ERCP组住院时间明显少于PTCD组（P <0.05）。术后1周ERCP组肝功能检测指标明显优于PTCD组（P <0.05）。此外，PTCD组和ERCP组的并发症发生率分别30.0%与10.0%。ERCP组的并发症发生率明显低于PTCD组（P <0.05）。结论 ERCP支架置入与PTCD解除胆道恶性梗阻疗效相似。但是，ERCP术后胆道通畅时间长，并发症少，患者肝功能指标恢复快。因此，对于肝外胆道恶性梗阻的患者，采用ERCP临床疗效更好，安全性更高。

Abstract:

Abstract: Objective To investigate efficacy and safety of biliary metallic stent placement via endoscopic retrograde cholangiopancreatography (ERCP) for malignant extrahepatic biliary obstruction. Methods According to different methods, 40 patients with malignant biliary obstruction were divided into PTCD group and ERCP group. Patients in PTCD group received percutaneous puncture bile duct drainage (PTCD) treatment, patients in ERCP group received placement of metal stents under ERCP. Results The survival time of the two groups were significant difference (P < 0.05). Postoperative biliary patency time in ERCP group was significantly longer than that in PTCD group, the difference was statistically significant (P < 0.05). One week later, the index for liver function of ERCP group was significantly better than that in PTCD group (P < 0.05). Additionally, the incidence of complications of PTCD group amd ERCP group was 30.0% and 10.0%, respectively. The complication rate of ERCP group was significantly lower than PTCD group (P < 0.05). Conclusion The effect of ERCP stent implantation is similar to that of PTCD in the treatment of malignant biliary obstruction. However, after ERCP, the time of biliary tract patency is longer with less complications and the index of liver function is recovered quickier than that after PTCD. Therefore, for the patients with malignant extrahepatic biliary obstruction, ERCP holds better clinical efficacy and safety.