CAJ | 학술논문

目的评价不同方法胆道支架植入术对难治性胆总管结石的疗效.方法将137例难治性胆管结石患者随机分成4组,单根支架组(A组)32例;单根支架加药物治疗组(B组)35例;双根支架组(C组)33例;双根支架加药物治疗组(D组)37例.在ERCP成功后植入1根或2根支架,药物治疗组在病情平稳后应用熊去氧胆酸和(或)茴三硫,对所有患者进行密切随访.结果所有患者3个月后胆石均有缩小,C组、D组缩小的幅度显著超过A组、B组(P＜0.05);支架通畅时间平均7.6个月,最长为20.0个月,其中D组的支架通畅时间最长,4组间两两比较均有统计学差异(P＜0.05);对72例(52.6%)进行了第2次ERCP,其中84.7%患者(61/72)取净了结石;本组发生高淀粉酶血症41例(29.9%),以双支架组为多(P＜0.05).结论对于难治性性胆总管结石,支架植入术是一种安全、有效的姑息疗法,尤以双支架加溶石药物疗效最佳.
목적 평개불동방법담도지가식입술대난치성담총관결석적료효.방법 장137례난치성담관결석환자수궤분성4조,단근지가조(A조)32례;단근지가가약물치료조(B조)35례;쌍근지가조(C조)33례;쌍근지가가약물치료조(D조)37례.재ERCP성공후식입1근혹2근지가,약물치료조재병정평은후응용웅거양담산화(혹)회삼류,대소유환자진행밀절수방.결과 소유환자3개월후담석균유축소,C조、D조축소적폭도현저초과A조、B조(P＜0.05);지가통창시간평균7.6개월,최장위20.0개월,기중D조적지가통창시간최장,4조간량량비교균유통계학차이(P＜0.05);대72례(52.6%)진행료제2차ERCP,기중84.7%환자(61/72)취정료결석;본조발생고정분매혈증41례(29.9%),이쌍지가조위다(P＜0.05).결론 대우난치성성담총관결석,지가식입술시일충안전、유효적고식요법,우이쌍지가가용석약물료효최가.
Objective To evaluate the efficacy of different methods of biliary stenting for intractable choledocholithiasis.Methods A total of 137 patients with intractable choledocholithiasis were randomly divided into 4 groups to receive different managements.The treatments included single biliary stent placement in group A (n=32),single stent placement plus oral medication in group B (n=35),double stents placement in group C (n=33) and double stents placements plus oral medication in group D (n=37).All biliary stents were placed via endoscopic retrograde cholangiopancreatography (ERCP).Oral medication included ursodeoxycholic acid and/or anethol trithione after the procedure.All patients were closely followed up.Results The size of stones in common bile duct (CBD) decreased in all cases at 3 months after stent placement,with most significant changes in groups C and D than in groups A and B (P＜0.05).The stents kept unobstructed for a mean time of 7.6 months (3.5-20 months),with a significant difference between every 2 groups (P＜0.05) and a longest duration time in group D.A second procedure of ERCP was performed in 72 patients (52.6%),with achievement of total choledocholithiasis clearance in 51 (84.7%).Hyperamylasemia (HA) occurred in 41 cases (29.9%),which were mainly observed in the groups C and D (P ＜0.05).Conclusion Biliary stent placement is a safe and effective palliative therapy for intractable choledocholithiasis,while double stents placements combined with pharmacotherapy is most effective.