经内镜与经皮肝穿刺胆道金属支架置入治疗肝外胆管恶性梗阻的对比分析

【目的】探讨应用不同方式胆道金属支架置入治疗肝外胆管恶性梗阻的效果，为临床上选择更适当的方法治疗晚期恶性梗阻性黄疸提供依据。【方法】回顾性分析本院2009年1月至2013年1月经内镜胆道金属支架置入术（EMBD）治疗肝外胆管恶性梗阻患者80例（EMBD组）及经皮肝穿刺胆管造影（PTC）胆道金属支架置入术治疗肝外胆管恶性梗阻患者80例（PTC组）的临床资料。比较两组的手术成功率、术后并发症发生率、支架通畅时间及患者生存期。【结果】两组患者术后肝功能均有明显改善，两组之间比较总胆红素（TB）、碱性磷酸酶（ALP）及谷氨酰基转移酶（GGT）下降程度无显著性差异（P＞0．05），PTC组的手术成功率高于 EMBD组，但并发症的发生率明显高于 EMBD组（P＜0．05）。两组病人术后支架通畅时间及生存期比较无显著性差异（P ＞0．05）。【结论】对于肝外胆道恶性梗阻患者可首选 EMBD，如手术失败可考虑经PTC途径行胆道支架置入。

Comparison of the Efficacy of Endoscopic vs.Percutaneous Transhepatic Biliary Metal Stent Place-ment for the Treatment of Malignant Extrahepatic Biliary Obstruction

[Objective]To explore the efficacy of different ways of metal stent placement for the treatment of advanced malignant obstructive jaundice in order to provide the basis for selecting better method for clinical treat-ment.[Methods]Clinical data of 80 patients with malignant extrahepatic biliary obstruction undergoing endoscopic biliary metal stent placement and 80 patients with malignant extrahepatic biliary obstruction undergoing percutane-ous transhepatic biliary metal stent placement in our hospital from Jan.2009 to Jan.2013 were analyzed retrospec-tively.The achievement ratio of operation,the incidence of postoperative complications,the unobstructed time of stents and the survival time of patients between two groups were compared.[Results]Liver function of two groups after operation was significantly improved.There was no significant difference in the decline of total bilirubin （TB）,alkaline phosphatase（ALP）and gamma glutamyl transferase（GGT）between two groups.The achievement ratio of percutaneous transhepatic biliary metal stent placement was higher than that of endoscopic biliary metal stent placement,but the incidence of the complications of percutaneous transhepatic biliary metal stent placement was obviously higher than that of endoscopic biliary metal stent placement.There was no significant difference in the unobstructed time and survival time between two groups.[Conclusion]The first choice of treating the patients with malignant extrahepatic biliary obstruction is percutaneous transhepatic biliary metal stent placement.If the operation is failure,percutaneous transhepatic biliary stent placement by PTC can be considered.