ERCP胆管支架置入治疗晚期恶性梗阻性黄疸的疗效研究

目的 探讨内镜下逆行胰胆管造影(ERCP)胆管支架置入治疗晚期恶性梗阻性黄疸的临床疗效。 方法 选取2013年2月-2016年2月瑞安市人民医院晚期恶性梗阻性黄疸患者74例,所有患者均接受ERCP胆管支架置入治疗,观察患者基本情况、治疗效果、肝功能、免疫功能、术后并发症情况以及生存时间。 结果 74例患者中,胆管支架成功置入72例,操作成功率为97.3%;72例患者平均住院时间(14.74±4.26)d,平均住院费用为(25 446.59±3 264.55)元;术后1周,治疗总有效率为94.4%,患者血清直接胆红素(DBIL)、总胆红素(TBIL)、谷丙转苷酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷酰胺转肽酶(GGT)较术前均明显降低(均P<0.05);术后1周,患者CD4+、CD4+/CD8+水平较术前明显提高(P<0.05),CD8+水平较术前明显降低(P<0.05);患者术后并发症发生率为5.56%,平均生存时间为(14.25±5.38)个月。 结论 ERCP胆管支架置入治疗晚期恶性梗阻性黄疸疗效显著,能够明显改善患者肝功能、免疫功能及预后情况,可作为晚期恶性梗阻性黄疸的姑息治疗方法。 

Efficacy of insertion of bile duct stent through endoscopic retrograde cholangiopancreatography in the treatment of advanced stage malignant obstructive jaundice

Objective To investigate the clinical effect of insertion of bile duct stent through endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of advanced stage malignant obstructive jaundice (MOJ). Methods A total of 74 patients with advanced malignant obstructive jaundice in our hospital from February, 2013 to February, 2016 were selected, all patients were treated with insertion of bile duct stent through ERCP, and the basic situation, therapeutic effects, liver function, immune function, postoperative complications and survival time were observed. Results Among the 74 patients, 72 cases were successfully treated with biliary stent, the successful rate was 97.3%. The average hospitalization time was (14.74±4.26) days, and the average hospitalization cost was (25 446.59±3 264.55) yuan. One week after the operation, the total effective rate was 94.4%, the levels of serum direct bilirubin (DBIL), total bilirubin (TBIL), alanine glycosylase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and glutamyltranspeptidase (GGT) decreased significantly (P<0.05). One week after the operation, the levels of CD4+ and CD4+/CD8+ increased significantly (P<0.05) and the level of CD8+ decreased significantly compared with preoperative (P<0.05). The incidence of postoperative complications was 5.56% and the average survival time was (14.25±5.38) months. Conclusion The insertion of bile duct stent through ERCP in the treatment of advanced malignant obstructive jaundice has a significant effect, which can significantly improve the liver function, immune function and prognosis, and can be used as a palliative treatment for advanced malignant obstructive jaundice.