开腹与内镜下胆道支架置入治疗晚期恶性梗阻性黄疸的对比分析

目的：探讨开腹手术放置胆道支架与内镜下支架置入在恶性梗阻性黄疸患者临床治疗中的应用价值及适应症选择。方法：回顾分析35例不能根治切除的恶性梗阻性黄疸患者采用金属记忆合金胆道内撑支架经开腹手术置入（n=23）、经 ERCP 置入（n=12）完成胆汁内引流，比较手术前后肝功能变化情况。结果：所有患者均完成胆管末端支架置入达到内引流的目的。支架置入术后胆红素均在术后第1周下降约100μmol/L；术后第2周胆红素仍有继续下降；谷草转氨酶、谷丙转氨酶、碱性磷酸酶及谷氨酰转肽酶在术后第1周开始较术前明显下降。主要并发症有胆管炎2例，胰腺炎2例，胆道出血3例。结论：胆道支架经开腹手术置入与经 ERCP 置入均可有效解除恶性梗阻性黄疸患者胆管梗阻，改善肝功能，提高患者生活质量，延长生存时间。临床根据病情选择合适的胆道支架置入方式，达到个体化治疗，以提高胆道支架置入的安全性、有效性。

Comparative analysis of the treatment of advanced malignant obstructive jaundice and abdominal endoscopic biliary stenting

Objective To discuss the value of biliary stent in treatment of the unresectable malignant biliary obstruction with endoscopic stent insertion and operation stent insertion. Methods thirty-five cases of malignant biliary obstruction whose biliary stent insertions were through operation(n=23), ERCP(n=7)respectively were reviewed retrospectively. Results The bile duct stents were successfully inserted in all patients through the malignantobstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100 μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion. Complications included 2 cases of cholangitis, 2 cases of pancreatitis and 3 cases of bile duct hemorrhage. Conclusion The bile duct stent insertions through op-eration and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to de-crease the occurrence of complications.