胰头癌梗阻性黄疸病人经内镜逆行胰胆管造影引流术疗效分析

目的探讨经内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)引流术对胰头癌梗阻性黄疸病人的治疗作用。方法对49例胰头癌梗阻性黄疸病人实施ERCP引流术,观察病人临床症状、肝功能变化及有无并发症等情况。结果 49例病人均成功完成ERCP手术操作,其中采用内镜下鼻胆管引流(endoscopic nasobiliary drainage,ENBD)5例,内镜下胆道支架置入术(endoscopic endoprothesis metal biliary drainage,EMBD)40例(包括金属及塑料支架),EMBD+ENBD4例。术后病人黄疸、纳差、乏力及皮肤瘙痒等症状减轻或消失;血清总胆红素、直接胆红素、间接胆红素、丙氨酸转氨酶,天冬氨酸转氨酶、碱性磷酸酶、γ-谷氨酰转移酶均明显下降(P0.05);未出现严重并发症,安全性良好。结论 ERCP引流术作为一种微创的治疗手段,引流效果好,并发症发生率低,可作为胰头癌梗阻性黄疸病人姑息治疗的首选方法。

The effects of ERCP drainage in carcinoma of head of pancreas patients with obstructive jaundice

Objective To evaluate the effects and safety of endoscopic retrograde cholangio-pancreatography(ERCP) drainage in carcinoma of head of pancreas patients with obstructive jaundice.Methods A total of 49 carcinoma of head of pancreas patients with obstructive jaundice were given ERCP drainage operation.The clinical symptoms,liver function,and complications were observed.Results The operation was successfully completed in 49 patients.Among them,5 patients underwent endoscopic nasobiliary drainage (ENBD),40 patients endoscopic endoprothesis metal biliary drainage (EMBD) (including metal and plastic stent),and 4 cases EMBD + ENBD.The clinical symptoms,including jaundice,anorexia,fatigue,and itchy skin were alleviated or disappeared after ERCP operation.Serum total bilirubin,direct bilirubin,alanine aminotransferase,aspartate amino transferase,alkaline phosphatase and γ-Glutamyl transferase were decreased significantly (P＜0.05).No serious postoperative complications appeared.Conclusions ERCP drainage might be the priority therapy due to its good effects and safety in carcinoma of head of pancreas with obstructive jaundice.