经内镜逆行胆管支架置入在恶性胆管狭窄姑息性减黄 治疗中的有效性和安全性分析

目的探讨经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）置入胆管支架治疗恶性胆管狭窄所致梗阻性黄疸的有效性及安全性，筛选胆管支架引流效果预测指标。方法采用ERCP技术对106例不能手术切除的恶性胆管狭窄病人行胆管支架置入治疗。根据分析目的不同分为:恶性胆管狭窄肝门部与远端组；恶性肝门部胆管狭窄BismuthⅠ型与Ⅱ~Ⅳ型组；恶性肝门部胆管狭窄BismuthⅡ~Ⅳ型中单侧支架与双侧支架组；恶性远端胆管狭窄中塑料支架与金属支架组；支架引流有效与无效组。记录术前、术中及术后相关指标，比较术前术后及各组引流效果、术后并发症发生情况，分析筛选可能影响支架引流效果的相关指标。结果106例病人术后1周内血清总胆红素水平较术前明显下降（P < 0.05），引流有效率70.8%。Bismuth Ⅰ型组、金属支架组引流有效率分别明显高于BismuthⅡ~Ⅳ型组、塑料支架组（P < 0.05）。恶性肝门部胆管狭窄较远端胆管狭窄的术后急性胰腺炎及急性胆管炎的发生率明显升高（P < 0.05）。术前血清白蛋白水平及术中回抽淤积胆汁量与引流效果呈明显正相关（P < 0.05）。结论经ERCP置入胆管支架的姑息性减黄治疗安全有效，但对于引流效果及术后并发症相对风险较高之BismuthⅡ~Ⅳ型组应谨慎对待。术前血清白蛋白水平及术中回抽胆汁量可预测支架引流效果。

Efficacy and safety of endoscopic retrograde bile duct stent placement in the palliative treatment of malignant biliary stricture

ObjectiveTo estimate the efficacy and safety of bile duct stent placement by endoscopic retrograde pancreatic angiography(ERCP) in the treatment of obstructive jaundice caused by malignant biliary stricture, and screen the predictive index of bile duct stent drainage effect.MethodsOne hundred and six patients with unresectable malignant bile duct stricture diagnosed by ERCP were treated with bile duct sent placement.According to the purpose of analysis, the patients were divided into the malignant bile duct stricture liver hilum and distal group, malignant hepatic bile duct stricture Bismuth type Ⅰ and Ⅱ-Ⅳ group and malignant hepatic bile duct stricture Bismuth type Ⅱ-Ⅳ unilateral stent and bilateral group, malignant distal bile duct stricture plastic stent and metal stent group and effective and ineffective stent drainage group.The preoperative, intraoperative and postoperative related indicators were recorded, the preoperative and postoperative drainage effects and postoperative complications in each group were compared, and the related indicators affecting the stent drainage effects were analyzed and screened.ResultsThe serum level of total bilirubin in 106 cases within 1 week after operation was significantly lower than that before operation(P < 0.05), and the effective drainage rate was 70.8%.The effective drainage rates in Bismuth Ⅰ group and metallic stent group were significantly higher than that in Bismuth Ⅱ-Ⅳ and plastic stent group(P < 0.05).The incidence rates of acute pancreatitis and cholangitis patients with malignant hilar bile duct stricture significantly increased compared with patients with distal bile duct stricture(P < 0.05).The preoperative serum albumin level and intraoperative congested bile volume were positively correlated with drainage effect(P < 0.05).ConclusionsBile duct stent placement by ERCP in the treatment of malignant biliary stricture is safe and effective, but Bismuth Ⅱ-Ⅳ cases should be treated with caution because of higher risks of ineffective drainage and complications.The preoperative serum ALB level and amount of congested bile can predict the drainage efficacy.