胆管恶性梗阻的内镜治疗

目的研究经内镜下塑料支架和金属支架对胆管恶性梗阻的治疗效果。方法将我院2010年1月至2012年6月经ERCP确诊为胆管恶性梗阻的120例患者,分成金属支架引流术组（EMBE）（n=62）和塑料支架引流术组（ERBD）（n=58）,监测两组患者血清总胆红素、谷丙转氨酶、碱性磷酸酶、谷氨酰胺转肽酶、血清TNF-α等的变化,并统计分析两组患者并发症的发生率以及死亡率。结果两组插管成功率及并发症发生率为均无明显差异（P〉0.05）,无死亡病例。治疗1周后复查两组患者的肝功能各项指标,结果较治疗前有统计学差异（P〈0.05）。两组成功随访89例,随访率为74.16%（89/120）,12例ERBD患者发生支架阻塞,占30.77%（12/39）,该组中位生存期为5个月。6例EMBE患者发生支架阻塞,占12%（6/50）,该组中位生存期为9.3个月,两组比较P均〈0.05。结论从随访看,支架阻塞发生率和中位生存期EMBE组均优于ERBD组,但两组均能有效的建立胆管内引流,改善患者的肝功能,具有创伤小、痛苦少、恢复快、无体外留管、符合生理过程等优点。

The endoscopic treatment of malignant biliary obstruction

Objective To study the efficacy of endoscopic naso-biliary drainage （ENBD） and endo- scopic metal biliary endoprothesis （EMBE） for the patient with malignant biliary obstruction. Methods One hundred and twenty patients with malignant biliary obstruction confirmed by ERCP were divided into 2 groups： EMBE group （n = 62） and ERBD group （n = 58）, serum TBIL, ALT, ALP, GGT, TNF-et, the incidence of complications, and mortality of two groups were analyzed. Results There were no significant differences based on intubation success rate and complication rate between two groups （P 〈 0.05）, with no deaths. One week after the treatment, the parameters of the liver function were significantly better than before treatment （P 〈 0.05）. Eigty-nine patients were successfully followed-up, with the rate of 74.16%（89/120）. Stent occlusion occurred in 12 cases in ERBD group, accounting for 30.77%（12/39）, and 6 cases in the EMBE group, account- ing for 12%（6/50）. The median survival time was 5 months in ERBD group, and 9.3 months in EMBE group （P 〈 0.05）. Conclusion From the situation of the follow-up, the incidence of stent occlusion and the median survival time in EMBE group were better than ERBD group, also ENBD and EMBE could effectively establish bile duct draina~,e, imorove liver function in oatients with malignant biliarv obstruction.