CAJ | 학술논문

目的探讨经内镜放置胆管支架治疗恶性胆管梗阻的效果.方法 176例失去手术机会的恶性胆管梗阻患者于经内镜逆行胰胆管造影下放置胆管支架,其中70例行胆管单塑料支架引流术(单支架组),2例行胆管双塑料支架引流术(双支架组),4例行胆管金属支架引流术(金属支架组),对比研究各组的引流效果及早期并发症的发生情况.结果术后1周时,单支架组、双支架组和金属支架组的谷丙转氨酶、总胆红素、直接胆红素和碱性磷酸酶水平均较治疗前显著下降(P值均<0.05);双支架组和金属支架组的总胆红素和直接胆红素水平均显著低于单支架组(P值均<0.05),而双支架组与金属支架组间的差异无统计学意义(P值均>0.05).单支架组、双支架组和金属支架组的手术成功率分别为97.1%(68/70)、78.8%(41/52)和92.6%(50/54),单支架组的手术成功率显著高于双支架组(P<0.05),金属支架组与单支架组、双支架组的差异均无统计学意义(P值均>0.05).单支架组、双支架组和金属支架组早期并发症发生率分别为15.7%(11/70)、13.5%(7/52)和1.9%(1/54),单支架组、双支架组的早期并发症发生率显著高于金属支架组(P值均<0.05),单支架组与双支架组的差异无统计学意义(P>0.05).结论经内镜逆行胰胆管造影下放置胆管支架对于恶性胆管梗阻有肯定的引流效果,双支架和金属支架的引流效果优于单支架.
목적 탐토경내경방치담관지가치료악성담관경조적효과.방법 176례실거수술궤회적악성담관경조환자우경내경역행이담관조영하방치담관지가,기중70례행담관단소료지가인류술(단지가조),2례행담관쌍소료지가인류술(쌍지가조),4례행담관금속지가인류술(금속지가조),대비연구각조적인류효과급조기병발증적발생정황.결과 술후1주시,단지가조、쌍지가조화금속지가조적곡병전안매、총담홍소、직접담홍소화감성린산매수평균교치료전현저하강(P치균<0.05);쌍지가조화금속지가조적총담홍소화직접담홍소수평균현저저우단지가조(P치균<0.05),이쌍지가조여금속지가조간적차이무통계학의의(P치균>0.05).단지가조、쌍지가조화금속지가조적수술성공솔분별위97.1%(68/70)、78.8%(41/52)화92.6%(50/54),단지가조적수술성공솔현저고우쌍지가조(P<0.05),금속지가조여단지가조、쌍지가조적차이균무통계학의의(P치균>0.05).단지가조、쌍지가조화금속지가조조기병발증발생솔분별위15.7%(11/70)、13.5%(7/52)화1.9%(1/54),단지가조、쌍지가조적조기병발증발생솔현저고우금속지가조(P치균<0.05),단지가조여쌍지가조적차이무통계학의의(P>0.05).결론 경내경역행이담관조영하방치담관지가대우악성담관경조유긍정적인류효과,쌍지가화금속지가적인류효과우우단지가.
Objective To evaluate the efficacy of endoscopic placement of biliary stent in treatment of malignant biliary obstruction. Methods A total of 176 patients with maligmant biliary obstruction,who had lost the chance for surgery,were treated with biliary stent through endoscopic retrograde cholangiopancreatography. Seventy patients received endoscopic retrograde biliary drainage with single stent,52 patients with double stents,and 54 patients with endoscopic metal biliary endoprothesis. The drainage outcomes and the early complications were compared between different groups. Results The levels of alkaline phosphatase (ALT),total bilirubin (TB),direct bilirubin (DB) and alkaline phosphatase (AKP) in the three groups were significantly decreased after operation compared with before operation (P<0.05). The post-stenting levels of TB and DB of in double stent and metal stent groups were significantly lower than those of the single stent group (P<0. 05),but with no significant difference found between the former two groups (P>0.05). The successful rate of single stent group (97.1%) was significantly higher than that of the double stent group (78.8%,P<0.05),but they were not significantly different from that of the metal stent group (92.6%)(P>0.05). The incidences of early complications of the single stent (15.7 %) and double stent (13.5 %) groups were significantly higher than that of metal stent (1.9 % group,but with no significant difference found between the former two (P>0. 05). Conclusion Endoscopic stenting is effective in treatment of malignant biliary obstruction,and the efficacies of endoscopic retrograde biliary drainage with double stent and metal biliary endoprothesis are better than that with single stent.