肝门胆管癌ERCP治疗前胆管过度引流的疗效探讨

目的探讨过度引流在肝门胆管癌ERCP治疗前的作用。方法肝门胆管癌患者39例行内镜置管引流术，随机分为两组，研究组18例患者不造影鼻胆管过度引流（ENBD），4～7d后胆管造影放置塑料支架（ERBD）或金属支架（EMBE）。对照组21例常规逆行胰胆管造影（ERCP）并胆管引流。观察术后并发症和疗效。结果两组效果满意。研究组1例高热，未出现严重并发症。对照组死亡1例，转开腹1例。研究组术后并发症明显低于对照组。金属支架通畅期略长于塑料支架，但价格昂贵且并发症发生率高。结论肝门胆管癌内镜治疗可达到姑息减压、减黄的目的，但要慎重造影和置放金属支架。术前过度引流可预防和降低术后并发症。

Effect of preoperative biliary drainage on hilar cholangiocarcinoma in patients underwent ERCP treatment

Objective To observe the effect of preoperative biliary drainage on hilar cholangiocarcinoma in patients underwent ERCP treatment. Methods 39 patients with hilar cholangiocarcinoma were randomly divided into experimental group and control group. In experimental group, 18 patients were treated by ENBD without cholangiography. After 4 - 7 days, the patients were treated by ERCP and Biliary biliary stents were inserted. In control group,21 patients were treated by routine ERCP and biliary drainage were performed. Results The therapeutic effects were satisfactory. In experimental group, only one patient appeared high feaver,no severe operation -related complication was present. In control group,one patient died and one patient was converted to open surgery. The postoperative complications in experimental group was obviously lower than that in control group. The unobstructed period of EMBE was relatively longer than that of ERBD. But its price and complication rate was higher. Conclusion Endoscopic biliary stent insertion in treatment of hilar cholangiocarcinoma can effectively relieve malignant biliary obstruction. Cholangiography and biliary metal stents should be taken with caution. Preoperative biliary drainage on hilar cholangiocarcinoma can prevent and decrease postoperative complications.