恶性胆道梗阻患者内镜逆行胰胆管造影术下放置不同支架的疗效及生存分析

Efficacy and survival analysis of different stents placement under endoscopic retrograde cholangiopancreatography in patients with malignant biliary obstruction

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）下放置不同支架用于恶性胆道梗阻（MBO）的临床疗效，及其对生存时间的影响。方法 收集2020年1月－2024年3月该院接受ERCP下支架放置治疗的MBO患者109例，分为可回收支架组（33例）、金属支架组（42例）和普通支架组（34例）。比较3组患者术前和术后肝功能变化情况、远期胆管炎和术后胰腺炎并发症发生情况、支架通畅时间、支架取出一次钳取成功率和生存时间，监测随访情况。结果 支架放置前，3组患者肝功能比较，差异无统计学意义（P > 0.05）；支架放置后1周，可回收支架组和金属支架组直接胆红素（DBiL）和总胆红素（TBiL）较术前差值明显大于普通支架组，普通支架组与两组比较，差异均有统计学意义（P < 0.05）。可回收支架组术后远期胆管炎发生率最低，其次为普通支架组，金属支架组胆管炎发生率最高，差异有统计学意义（P < 0.05），3组患者术后胰腺炎发生率比较，差异无统计学意义（P > 0.05）；可回收支架组相比于普通支架组，支架取出一次性钳取成功率更高。金属支架组中位通畅时间为194.0 d，可回收支架组为126.0 d，普通支架组为92.0 d，3组患者支架中位通畅时间比较，差异有统计学意义（P < 0.01）。可回收支架组中位生存时间为590.0 d，金属支架组为476.0 d，普通支架组为453.0 d，3组患者中位生存时间比较，差异有统计学意义（P = 0.023）。结论 使用可回收塑料胆道支架，术后胆红素下降更快，相比于普通塑料胆道支架，可回收塑料胆道支架置入术后，远期胆管炎发生率更低，支架一次性钳取成功率更高，支架通畅时间及生存时间方面更有优势，是MBO患者ERCP支架置入术的一种有效选择方式。

Abstract:

Objective To investigate the clinical efficacy of different stents placement under endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliary obstruction (MBO) and the effect on patient survival time.Methods Clinical data of MBO patients treated with ERCP stent placement between January 2020 and March 2024 were collected, divided into recyclable stent group (33 cases), metal stent group (42 cases), and ordinary stent group (34 cases). Comparation of the three groups of preoperative and postoperative changes in liver function, complications of long-term cholangitis and pancreatitis, stent patency time, success rate of stent removal with a single clamping, survival time, monitoring follow-up situation.Results There was no statistically significant difference in the liver function of the three groups of patients before stent placement (P > 0.05); One week after stent placement, the difference compared with preoperative between direct bilirubin (DBiL) and total bilirubin (TBiL) in the recyclable stent group and the metal stent group was significantly higher than that in the ordinary stent group, and the difference between the ordinary stent group and other two groups was statistically significant (P < 0.05). The incidence of cholangitis in the recyclable stent group was the lowest, followed by the ordinary plastic biliary stent, and the metal biliary stent had the highest incidence of cholangitis, the incidence of cholangitis in the long term after stent placement was compared among the three groups of patients with a statistically significant difference (P < 0.05). The incidence of postoperative pancreatitis in the three groups was not statistically significant (P > 0.05). The success rate of stent removal with a single clamping was higher in the recyclable stent group than the ordinary stent group.Comparison of median stent patency time among the three groups, the difference was statistically significant (P < 0.05).The metal stent group had the longest median patency time of 194.0 d, recyclable plastic stent had the second longest median patency time of 126.0 d, and ordinary plastic biliary stent had the shortest median patency time of 92.0 d. Median survival time among the three groups was statistically significant (P < 0.05). The recyclable plastic biliary stent had the longest median survival time of 590.0 d, metal biliary stent had the second longest median survival time of 476.0 d, and ordinary plastic biliary stent had the shortest median survival time of 453.0 d.Conclusion Recyclable plastic biliary stent has a faster decrease in bilirubin index compared with the ordinary stent group after operation. And the recyclable plastic stent group has lower incidence of long-term cholangitis, higher success rate of one-time clamping of the stent, and more advantages in time to stent patency and survival time compared with ordinary plastic biliary stent, which is an effective choice of stenting modality for ERCP stent placement in patients with MBO.