1 215例次恶性胆管梗阻内镜治疗的体会

目的探讨采用治疗性内窥镜逆行胰胆管插管技术(ERCP技术)，姑息性解除恶性肿瘤所致胆管梗阻的可行性。方法采用ERCP治疗929例1215例次胆管恶性梗阻，包括胆管癌567例次、肝癌255例次、胆囊癌83例次、胰腺癌172例次、乳头壶腹癌97例次、其它转移性肿瘤41例次;导致胆管低位梗阻263例次、中段梗阻43例次、高位梗阻909例次；血清胆红素（284.3±174.5）μmol/L。共行胆道内置管引流599例次、鼻胆管引流385例次，放置可膨式金属胆道支架167例次，联合引流39例次，乳头括约肌切开19例次，乳头开窗造口术6例次。结果操作成功率94.3%，消除黄疸总有效率81.8%，治疗后患者平均生存14个月，1、2、3年的预计存活率分别为75.9%、44.0%和25.2%。全组发生与操作有关并发症23例（2.6%），死亡3例（0.2%）。结论内镜介入治疗技术是安全有效解除胆道恶性梗阻的方法，对中晚期胆道肿瘤患者基本可替代姑息性胆道手术。

Endoscopic management of 1 215 malignant bile duct obstructions

Objective　To review the experience with endoscopic palliation of malignant obstructive jaundice (MOJ) in 929 patients.　Methods　From 1994 to 1998, 929 patients (598 Males and 331 females) underwent 1 215 endoscopic palliation drainages for MOJ in our hospital. The mean age of these patients was 57 years (range 8-86). Tumor obstruction occurred in the distal CBD (263 patients), the middle CBD (43), and the hilum (909), with a mean bilirubin level of 284 μmol/L (range 26-810). Of the 1 215 drainages, 599 were performed by stenting with plastic endoprosthesis, 385 by nasobiliary catheterization, 167 by expandable metal stents, 39 by combined drainage methods, 19 by tumor papillotomy, and 6 by endoscopic fistulostomy. 　Results　The success rate of endoscopic procedure was 94.3%. Jaundice was inproved in 81.8% of the patients with a significant reduction of serum bilirubin (64.7%). Post-drainage complication rate was 2.6%; which couplications included cholangitis (23 patients), pancreatitis (8), and bleeding (1). The overall drainage-related mortality rate was 0.2%, mainly due to uncontrolled cholangitis and renal failure. The median survival rate of all patients was 14 months; life time analysis showed a life expectancy of 76%, 44% and 25% at 1, 2 and 3 year respectively.　Conclusions　In patients with MOJ secondary to pancreatobiliary malignancy, successful endoscopic drainage provides adequate relief of biliary obstruction and is associated with low morbidity and mortality. Endoscopic interventional treatment should be an alternate of palliative biliary operation for the terminal stage of pancreatic and biliary malignancies.