跨Vater壶腹放置胆道支架的近期安全性评价

目的探讨跨Vater壶腹放置胆道支架的近期安全性。方法选择84例接受胆道支架植入术的患者按照支架植入方式不同分为A、B 2组。A组37例为跨壶腹放置,B组47例为非跨壶腹放置,分别对2组患者术前、术后总胆红素及白细胞变化情况和术后近期并发症发生情况进行统计分析。结果 2组患者术前、术后1周、术后2周总胆红素及白细胞数比较差异无统计学意义(P>0.05)。2组患者术后1周、术后2周总胆红素与术前比较差异均有统计学意义(P<0.05)。2组患者术后1周白细胞数与术前比较差异有统计学意义(P<0.05);术后2周与术前比较差异无统计学意义(P>0.05)。2组患者高淀粉酶血症发生率、胰腺炎发生率及胆道出血发生率比较,差异均无统计学意义(P>0.05)。A组患者中12例(32.4%)患者出现发热伴腹痛、恶心、呕吐等不适,B组患者中5例(10.6%)出现发热伴腹痛、恶心、呕吐等不适,2组比较差异有统计学意义(P<0.05)。结论跨Vater壶腹放置胆道支架是一种安全、有效的胆道支架植入方式,对累及壶腹部的肿瘤患者可以考虑常规选用。

Evaluation of recent safety on the placement of biliary stents by acrossing the Vater ampulla

Objective To explore the recent safety on the placement of biliary stents by acrossing the Vater ampulla. Methods Totally 84 patients who underwent the placement of biliary stent were selected and divided into group A and group B according to the implantation style. The patients in group A（ n = 37）were placed bfliary stents by acrossing the ampulla,and the patients in group B（ n = 47）were placed biliary stents by non-aerossing the ampulla. The total bilirubin, changes of white blood cells before and after operation and recent complication after operation were compared between the two groups. Results There was no statistic difference of total bilirubin levels and the changes of white blood cells between the two groups before operation, one week and two weeks after operation（P 〉 0.05）. There was statistic difference of total bilirubin between before operation and one week, two weeks after operation in the two groups （P 〈 0.05 ）. There were statistic difference of changes of white blood cells between before operation and one week after operation in the two groups（ P 〈 0.05 ）, but there was no statistic difference between before operation and two weeks after operation（ P 〉 0. 05 ）. There was no statistic difference of the incidence of the hyperamylasemia, pancreatitis, and biliary duct bleeding between the two groups（ P 〉 0.05 ）. There were 12 patients（ 32. 4% ）in group A occurred discomfortable symptoms including fever, abdominal pain, nausea and vomit ,while only five patients （10.6%） in group B occurred the same symptoms;and the differences between the two groups were statistical significant （P 〈 0.05 ）. Conclusion The placement of biliary stent by acrossing the Vater ampulla ia a safe and effective impantation way. It can be routinely selected for patients with tumors involving the ampulla.