恶性梗阻性黄疸行内镜下胆道金属支架引流术的临床疗效观察

目的探讨恶性梗阻性黄疸行内镜下胆道金属支架引流术(EBMSD)的临床疗效。方法选取本院2008年1月至2013年6月接受EBMSD治疗的48例恶性梗阻性黄疸患者为研究对象,统计学比较患者术前及术后各实验室指标改变,评价疗效。结果成功置入金属支架44例,支架置入技术成功率为91.67%,其中行单支引流34例,左右双支引流10例。44例患者术后7天检查肝功能较术前有显著改善,血清胆红素(总胆红素、直接胆红素)显著下降,明显低于术前(P0.01),丙氨酸转氨酶、天门冬氨酸氨基转移酶、碱性磷酸酶也较术前显著下降(P0.01),左右双支引流肝功能指标降低效果优于单支引流(P0.01),后并发症较轻,经对症治疗后均好转。术后对患者随访6~12个月,完成随访38例,失访6例,38例随访患者中总体3个月、6个月存活率分别达到94.25%和73.39%。结论采用EBMSD治疗恶性阻塞性黄疸疗效明显,可有效缓解黄疸症状,提高患者的生活质量,且左右双支引流效果优于单支引流。     

经内镜胆道金属支架引流术治疗胆管远端恶性梗阻的临床观察

目的探讨经内镜胆道金属支架引流术治疗胆管远端恶性胆道梗阻患者的疗效。方法回顾性分析我院自2007年5月至2012年12月经内镜金属支架置入治疗胆管远端恶性梗阻性黄疸患者的成功率、减黄有效率及并发症。结果支架置入成功86例,置入失败6例,支架置入成功率93.5%(86/92),减黄满意率为86%(74/86),减黄一般率为12.8%(11/86),减黄无效率为1.2%(1/86),术后胆管炎2例、胰腺炎8例、出血5例。结论经内镜胆道金属支架引流术治疗低位恶性胆道梗阻疗效好、安全有效,是不能或不愿意接受手术治疗患者的首选。     

内镜下胆管支架置入引流术治疗恶性梗阻性黄疸18例体会

恶性梗阻性黄疸（MOJ）是指由原发性胆管癌、胰腺癌、肝癌等或其他部位癌肿淋巴结转移压迫胆管而引起的梗阻性黄疽,临床床确诊时已无法手术切除,多采用姑息治疗。为了延长这些患者的生存时间、提高其生活质量。2003年3月～2005年5月,我们对不能实施手术切除的18例MOJ患者行内镜下胆管支架置入引流术,效果满意。现报告如下。     

两种不同引流途径行胆道金属支架引流术对恶性梗阻性黄疸姑息性的治疗效果

目的 探讨采用两种不同引流途径行胆道金属支架引流术(EMBE)减黄治疗恶性梗阻性黄疸(MOJ)的效果和安全性。方法 选择2019年1月至2021年9月海安市中医院收治的MOJ患者112例,根据随机数字表示法分成观察组和对照组,每组各56例。观察组采用经内镜逆行性胰胆管造影术(ERCP)行EMBE治疗,对照组采用经皮肝穿刺胆道引流术(PTCD)行EMBE治疗。观察围术期指标,炎症免疫和肝功能更指标的变化,以及治疗效果和安全性。结果 两组的手术时间和术中出血量差异无统计学意义(P>0.05);ERCP组开始下床时间、首次住院时间和住院总费用为(29.46±6.30)h、(4.52±0.76)d和(3.93±0.47)万元,低于PTCD组的(32.75±6.25)h、(5.19±0.85)d和(4.46±0.58)万元,差异有统计学意义(t=6.527、6.293、6.043,均P<0.05)。治疗7 d后,两组的NLR、TNF-α和sIL-2R水平均较治疗前显著下降(P<0.05),治疗后组间差异无统计学意义(P>0.05)。ERCP组的TBil、ALP和Alb为(...     

经内镜胆管引流术治疗梗阻性黄疸21例

经内镜胆管引流术治疗梗阻性黄疸２１例沂水中心医院（２７６４００）张传汶费志勇陈兴田沈玉法赵希英１９９７年４月以来，我们经内镜行胆管引流术治疗梗阻性黄疸患者２１例，疗效较好。１资料与方法本组男１４例，女７例；年龄３４～７１岁，平均４９．７岁。其中肝门部...     

内镜鼻胆引流在梗阻性黄疸中的应用

23例梗阻性黄疸患者进行了鼻胆引流术(ENBD),其中胆总管结石8例,胆总管末端及乳头部狭窄4例,胆管、壶腹和胰头部癌11例,4例并发急性化脓性胆管炎.结果.21例内镜下插管成功,成功率力91.3%.21中除2例术后鼻胆引流管堵塞外,其余病例均获得较好的疗效,有效率为82.6%.血清总胆红素、ALP刊r-GT治疗后明显下降.结论:ENBD是一种简便有效的胆道引流手段,临床上可以广泛地应用于各种原因所致的梗阻性黄疸.     

超声引导下 PTBD 治疗恶性梗阻性黄疸效果观察

目的探讨超声引导下经皮经肝胆道引流术(PTBD)在恶性梗阻性黄疸治疗中的应用。方法回顾性分析我院139例次行PTBD的恶性梗阻性黄疸患者的临床资料。结果 133例次一次穿刺置管引流成功,6例次为两穿刺引流成功,一次穿刺成功率为95.7%(133/139)。术后1周血清总胆红素、直接胆红素水平均低于术前(P<0.05)。结论超声引导下PTBD治疗恶性梗阻性黄疸疗效较好,能明显提高穿刺成功率,并降低患者的血清胆红素水平。     

内镜下金属支架置入治疗恶性幽门梗阻的临床应用

幽门恶性梗阻一旦出现,患者生活质量会迅速恶化。表现顽固性呕吐,不能进食,体重减轻,脱水,并且需要持续静脉补液。虽然外科手术可行姑息性治疗,但有相当一部分患者不能耐受手术。对不能手术或不愿手术患者的幽门梗阻可通过置入支架来治疗。虽然自膨式金属支架在食管梗阻已广泛应用,但在恶性幽门梗阻的姑息性治疗中由于支架置入的困难目前临床应用不多。     

超声内镜引导下胆汁引流治疗ERCP治疗失败的恶性梗阻性黄疸患者疗效初步研究

目的 探讨采用超声内镜引导下胆汁引流术(EUS-BD)和经皮肝胆管引流术(PTBD)再治疗经内镜逆行胰胆管造影术(ERCP)治疗失败的恶性梗阻性黄疸患者的有效性及安全性。方法 2013年1月～2018年12月我院收治的经ERCP治疗失败的恶性梗阻性黄疸患者75例,术前经B超、CT或MRCP等影像学检查证实存在恶性胆管梗阻,其中胰腺癌15例、壶腹部癌12例、胆管癌27例、胆囊癌9例、胃肠道恶性肿瘤侵犯11例和非霍奇金淋巴瘤1例。其中40例接受EUS-BD治疗,35例接受PTBD治疗。结果 在40例EUS-BD治疗患者中,采用超声内镜引导下对接技术完成治疗16例(40.0%),在超声内镜引导下顺行技术完成治疗24例(60.0%),其中37例(92.5%)操作成功,在35例PTBD治疗患者中,28例(80.0%)操作成功,EUS-BD治疗患者操作时间为治疗后,EUS-BD治疗患者血清总胆红素水平为(138.7±50.2)μmol/L,显著低于PTBD治疗患者的(162.4±60.2)μmol/L,而血清白蛋白水平为(34.8±3.7)g/L,显著高于PTBD治疗患者的(32.1±4.6)g/L,P<0.05];EUS-BD治疗患者术后并发症发生率为7.5%(3/40),其中胆道出血2例(5.0%),急性胆管炎1例(2.5%),PTBD治疗患者术后并发症发生率为22.9%(8/35,P<0.05),其中胆道出血3例(8.6%),肝包膜下出血1例(2.9%),胆汁性腹膜炎1例(2.9%),胆漏1例(2.9%),胆道感染2例(5.7%)。结论 在ERCP治疗失败的恶性胆道梗阻患者,可选择EUS-BD或PTBD进行补救治疗,或许可消退黄疸,暂时减轻病情。     

梗阻性黄疸的内镜治疗

对64例经ERCP及B超证实的梗阻性黄疸患者分别进行了乳头括约肌切开,网篮取石,胆总管内机械碎石,胆管气囊扩张,鼻胆引流及胆总管支架管引流.结果:①51例成功地进行了ERCP治疗,成功率为79.7%.②治疗后2周内胆总管直径较治疗前明显缩小(P<0.05);血清总胆红素、ALT及γ-GT较治疗前明显下降(P<0.05～0.01).③胆总管结石患者治疗后1周内腹痛缓解率为92.1%;退热率为100%.④并发症的发生率为7.8%,主要是乳头切开处出血、急性胰腺炎及结石嵌顿,经适当处理很快好转恢复.结果表明:梗阻性黄疸患者ERCP治疗具有患者损伤轻,痛苦小,耐受好及恢复快等优点,应作为单纯胆总管结石,特别是伴有胆囊或股道手术后及高龄患者的首选治疗方法.     

经内镜鼻胆管引流术与经内镜胆道支架置入术在低位恶性梗阻性黄疸术前胆道引流效果比较的Meta分析

目的比较经内镜鼻胆管引流术(ENBD)和经内镜胆道支架置入术(EBS)在低位恶性梗阻性黄疸术前胆道引流中的有效性及安全性。方法在中英文数据库中检索从建库至2020年8月发表的有关ENBD与EBS在低位恶性梗阻性黄疸术前胆道引流疗效对照研究的所有中英文文献,对纳入的研究进行质量评价和数据提取后,采用RevMan 5.3软件进行Meta分析,比较ENBD与EBS术前胆管炎发生率、术前胰腺炎发生率、支架障碍率、术前术后总并发症发生率、术后胰漏率的差异。结果最终纳入6项研究,包括1182例患者。Meta分析结果显示,在术前胰腺炎发生率、支架障碍率、术前术后总并发症发生率方面,ENBD组与EBS组比较差异均无统计学意义(OR分别为0.66、1.14、0.69,95%CI分别为0.44~0.99、0.56~2.31、0.41~1.15,P值分别为0.05、0.72、0.15)。但是,ENBD组相较于EBS降低了术前胆管炎发生率和术后胰漏率,差异均有统计学意义(OR分别为0.34、0.53,95%CI分别为0.23~0.50、0.32~0.88,P值分别为<0.00001、0.01)。结论对于诊断明确的低位恶性胆道梗阻患者,术前胆道引流使用ENBD优于使用EBS。未来需要更多的多中心大样本随机对照试验来验证这一结论。     

Percutaneous biliary metal wall stenting in malignant obstructive jaundice

BACKGROUND: Most patients with advanced stage malignant obstructive jaundice will be suitable for palliation only. Metallic stents are safe, effective and minimally invasive. DESIGN: A review of case notes of patients who had Wallstents inserted percutaneously from January 1996 to December 2000. RESULTS: Eighty-nine patients with a median age of 72 years underwent percutaneous insertion of biliary metal stents. The diagnoses were cholangiocarcinoma (41.5%), pancreatic carcinoma (40.5%), nodal metastases at the porta hepatis (14.6%) and gall bladder cancer (3.4%). Ninety-six per cent of patients improved their hyperbilirubinaemia to normal levels by 1 month. The median post-procedure hospital stay was 16 days. Early overall complications (within 30 days of stenting) occurred in 30% of patients (70% of these were disease related). The 30 day mortality rate was 20% (n = 18). Fifty (70%) patients were readmitted to hospital, most commonly because of carcinomatosis (16) or stent obstruction (12). The symptom-free period ranged from 2 weeks to 13 months. Median survival for all patients was 3.5 months. Survival correlated inversely with serum bilirubin at presentation (r = -0.34, P = 0.001), but not with other liver function tests. DISCUSSION: Metal wall stenting for malignant obstructive jaundice provides good palliation with low, procedure-related morbidity and mortality, but poor overall survival from disease-related morbidity. Survival significantly correlates with pre-stenting serum bilirubin levels. There is a need to identify the subgroup of patients in whom stenting has no beneficial effect.     

胆道支架引流术对恶性梗阻性黄疸患者肝功能的影响

目的探讨恶性梗阻性黄疸行内镜下胆道金属支架引流术(EBMSD)的临床疗效。方法选取北京军区总医院2012年1月-2014年4月接受EBMSD治疗的48例恶性梗阻性黄疸患者为研究对象,比较患者手术前后血清ALT、AST、ALP、TBil、DBil及GGT等肝功能指标的变化情况。计量资料组间比较采用t检验。结果 48例患者中,成功置入金属支架44例,手术成功率为91.67%,其中单支引流34例,双支引流10例。患者术后肝功能各项指标较术前均有所改善,TBil、DBil、ALT、AST、ALP及GGT均显著下降,差异具有统计学意义(P值均0.01);双支引流患者肝功能指标改善情况优于单支引流患者,差异具有统计学意义(P值均0.01);术后成功随访38例,随访患者3个月存活率为94.25%,6个月存活率为73.39%。结论采用EBMSD治疗恶性阻塞性黄疸疗效明显,可有效缓解临床症状,提高患者的生活质量,且左右双支引流效果优于单支引流。     

经皮经肝胆道引流治疗恶性阻塞性黄疸近期疗效与并发症观察

目的探讨经皮经肝胆道引流术治疗恶性阻塞性黄疸近期(1个月内)疗效,总结并发症发生率以及有效处理措施。方法回顾性分析88例在我科接受经皮经肝胆道引流术患者的病历资料。统计其在术后1个月内肝功能化验指标并与术前相比较;观察术后并发症及处理措施。结果83例患者血清总胆红素水平较术前降低30%以上,引流术的有效率为94.3%(83/88)。引流术后血清总胆红素、谷丙转氨酶、谷草转氨酶均较术前显著降低(P0.05)。引流术后并发症包括胆道感染、引流管全部或部分滑脱、胆道出血、引流管胆泥堵塞不通,其发生率依次为37.5%(33/88)、20.45%(18/88)、17.04%(15/88)、4.55%(4/88);其他少见并发症包括肺部感染、败血症、胰腺炎、死亡,其发生率均为1.13%(1/88)。除死亡患者外,其余并发症均经相应措施得到有效处理。结论经皮经肝胆道引流可有效改善恶性阻塞性黄疸患者肝功能,减轻黄疸;术后并发症以胆道感染居首位,严重并发症及死亡率低。     

经内镜放置胆管金属支架联合鼻胆管引流治疗恶性胆管梗阻

目的探讨经内镜放置胆管金属支架联合鼻胆管引流对恶性胆管梗阻的治疗效果。方法 115例失去手术机会的恶性胆管梗阻患者行经内镜逆行胰胆管造影下放置胆管支架,其中48例行胆管塑料支架引流术,30例行胆管金属支架引流术,37例行胆管金属支架联合鼻胆管引流术;分析各组引流效果、成功率、早期并发症和胆管再堵塞发生情况。结果塑料支架组、金属支架组及金属支架联合鼻胆管组的谷丙转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)和碱性磷酸酶(AKP)在手术后均有明显降低(P0.05);手术后1周金属支架联合鼻胆管组的TBIL和DBIL明显低于塑料支架组、金属支架组(P0.05),塑料支架组和金属支架组相比,差异无统计学意义(P0.05);术后3个月内金属支架组和金属支架联合鼻胆管组再堵塞的发生率明显低于塑料支架组(P0.05),金属支架组和金属支架联合鼻胆管组相比,差异无统计学意义(P0.05);塑料支架组的手术成功率与金属支架组及金属支架联合鼻胆管组相比,差异无统计学意义(P0.05),塑料支架组的早期并发症发生率明显高于金属支架联合鼻胆管组,差异有统计学意义(P0.05)。结论经内镜逆行胰胆管造影下放置胆管金属支架联合鼻胆管对于恶性胆管梗阻有确切的引流效果。     

outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy

AIM To compare the outcomes of preoperative endoscopic nasobiliary drainage(ENBD) and endoscopic retrograde biliary drainage(ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy(PD). METHODS Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. we compared the clinical data, procedure-related complications of endoscopic biliary drainage(EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios(ORs) and 95% confidence intervals(95%CIs) were used to identify the risk factors for deep abdominal infection after PD.RESULTS One hundred and two(66.7%) patients underwent ENBD, and 51(33.3%) patients underwent ERBD. Endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group(P = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group(P = 0.036). After EBD, the levels of total bilirubin(TB) and alanine aminotransferase(ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group(P = 0.004 and P = 0.000, respectively). However,the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group(P = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups(P = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group(P = 0.019). Male gender(OR = 3.92; 95%CI: 1.63-9.47; P = 0.002), soft pancreas texture(OR = 3.60; 95%CI: 1.37-9.49; P = 0.009), length of biliary stricture(≥ 1.5 cm)(OR = 5.20; 95%CI: 2.23-12.16; P = 0.000) and ERBD method(OR = 4.08; 95%CI: 1.69-9.87; P = 0.002) were independent risk factors for deep abdominal infection after PD.CONCLUSION ENBD is an optimal method for patients with malignant distal biliary obstruction prior to PD. ERBD is superior to ENBD in terms of patient tolerance and the effect of biliary drainage but is associated with an increased risk of EBD procedure-related cholangitis and deep abdominal infection after PD.     

经内镜胆道内支架放置术和鼻胆管引流术治疗各级急性胆管炎的效果比较

目的 比较经内镜胆道内支架放置术（ERBD）和经内镜鼻胆管引流术（ENBD）对各级急性胆管炎的治疗效果。方法 回顾性分析2009年1月至2017年6月在北京朝阳医院接受急诊经内镜逆行胰胆管造影术（ERCP）治疗的272例急性胆管炎患者资料,其中ERBD组143例,包括Ⅰ级（轻度）急性胆管炎63例,Ⅱ级（中度）51例,Ⅲ级（重度）29例;ENBD组129例,包括Ⅰ级（轻度）54例,Ⅱ级（中度）37例,Ⅲ级（重度）38例。分别比较两组总体患者和各级急性胆管炎患者的炎症缓解率、ERCP相关并发症发生率和引流干预率。结果 ERBD组和ENBD组总体炎症缓解率[89.5%（128/143）比94.6%（122/129）,χ2=2.399,P=0.126]及Ⅰ级[93.7%（59/63）比98.1%（53/54）,χ2=0.548,P=0.459]、Ⅱ级[90.2%（46/51）比94.6%（35/37）,χ2=0.125,P=0.724]、Ⅲ级患者炎症缓解率[79.3%（23/29）比89.5%（34/38）,χ2=0.657,P=0.418]比较,差异均无统计学意义。ERBD组和ENBD组总体并发症发生率[11.9%（17/143）比7.8%（10/129）,χ2=1.298,P=0.255]及Ⅰ级[9.5%（6/63）比7.4%（4/54）,χ2=0.006,P=0.939]、Ⅱ级[13.7%（7/51）比8.1%（3/37）,χ2=0.230,P=0.632]、Ⅲ级患者并发症发生率[13.8%（4/29）比7.9%（3/38）,χ2=0.144,P=0.705]比较,差异均无统计学意义。ERBD组和ENBD组总体引流干预率比较差异有统计学意义[10.5%（15/143）比3.1%（4/129）,χ2=5.699,P=0.017],Ⅰ级[6.3%（4/63）比1.9%（1/54）,χ2=0.548,P=0.459]、Ⅱ级患者引流干预率[9.8%（5/51）比5.4%（2/37）,χ2=0.125,P=0.724] 比较差异无统计学意义,但Ⅲ级患者比较差异有统计学意义[20.7%（6/29）比2.6%（1/38）,χ2=3.965,P=0.046]。结论 ENBD与ERBD对各级急性胆管炎的治疗具有相同的效果,但ENBD能够降低术后引流干预率。     

Combination of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography‐guided biliary drainage in malignant hilar biliary obstruction

Adequate biliary drainage (BD), defined as more than 50% of liver volume drained, is an ideal BD method in patients with advanced and unresectable malignant hilar biliary obstruction (MHBO). Endoscopic retrograde cholangiopancreatography (ERCP) with multi‐segmental BD is technically challenging. ERCP with percutaneous biliary drainage (PTBD) or PTBD alone has cumbersome maintenance of PTBD line and external bag. The utility of EUS‐guided BD (EUS‐BD) has risen significantly over last 5 years mostly in the clinical setting of distal bile duct obstruction. Information on EUS‐BD for malignant hilar biliary obstruction (MHBO) is thus far limited to only two small studies. This review suggests a new concept of a combination of ERCP and EUS‐BD (CERES) for BD in MHBO as a primary BD method whereby ERCP with a single self‐expandable metal stent (SEMS) is placed into either the right or the left intrahepatic bile duct (IHD). If SEMS is placed in the right biliary system, EUS‐guided hepaticogastrostomy (EUS‐HGS) can subsequently be carried out. However, if the stent is placed into the left biliary system, EUS‐guided hepaticoduodenostomy (EUS‐HDS) is done. For MHBO with non‐functioning right lobe of the liver, EUS‐HGS is carried out after failed ERCP, or primary HGS can be carried out in the left lobe of liver. For MHBO with non‐functioning left lobe of the liver, EUS‐HDS is carried out after failed transpapillary stenting of the right lobe by ERCP. Based on our experience, CERES is promising as it can fulfil gaps of both PTBD and ERCP by allowing internal drainage that can circumvent the inconvenience associated with PTBD and offer higher technical success rate compared to ERCP with bilateral SEMS placement.     

Effect of preoperative biliary drainage on malignant obstructive jaundice: a meta-analysis

AIM: To evaluate the effect of preoperative biliary drainage (PBD) on obstructive jaundice resulting from malignant tumors. METHODS: According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word preoperative biliary drainage. Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Da...