CAJ | 학술논문

目的探讨采用治疗性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,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39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,括约肌切开19例,乳头开窗术6例.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年、2年、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.
목적탐토채용치료성ERCP기술,고식성해제악성종류소치담관경조적가행성.방법채용ERCP치료929례1215례차,포괄담관암567례차、간암255례차、담낭암83례차、이선암172례차、유두호복암97례차、기타전이성종류39례차;도치담관저위경조263례차、중단경조43례차、고위경조909례차;혈청담홍소(284.3±174.5)μmol/L.공행담도내치관인류599례차、비담관인류385례차,방치가팽식금속담도지가167례차,연합인류39례차,괄약기절개19례,유두개창술6례.결과조작성공솔94.3%,소제황달총유효솔81.8%,치료후환자평균생존14개월,1년、2년、3년적예계존활솔분별위75.9%、44.0%화25.2%.전조발생여조작유관병발증23례(2.6%),사망3례(0.2%).결론내경개입치료기술시안전유효해제담도악성경조적방법,대중만기담도종류환자기본가체대고식성담도수술.
Objective To review the experience with endoscopic palliative treatment for malignant obstructive jaundice (MOJ) in 929 patients.Methods 929 patients (598 males and 331 females) underwent 1 215 endoscopic palliative drainages for MOJ in our hospital. Tumor ob-struction occurred in the distal common bile duct (CBD) (263 patients), the middle CBD (43), and the hilum (909). The mean biliru-bin level was 284.3μmol/L( range 26 - 810). Of the 1 215 drainages, 599 were performed by stenting with plastic endoprosthesis, 385 bynaso-biliary catheterization, 167 by expandable metal stents, 39 by combined drainage method, 19 by tumor sphincterotomy and 6 by en-doscopic fistulostomy.Results The successful rate of endoscopic procedure was 94.3 %. The jaundice symptom was improved in 81.8 % of the patients with asignificant reduction of serum bilirubin in 64.7 %. The complication after treatment occurred in 23 cases (2.6%), including cholangitis(23 cases), pancreatitis (8 cases), and bleeding (one case), and 3 cases were dead (0.2%). The median survival time of all patientswas 14 months and life time analysis showed a life expectancy of 75.9%, 44.0% and 25.2% at 1, 2 and 3 years respectively.Conclusion In the patients with MOJ secondary to pancreatobiliary malignancy, successful endoscopic drainage provides adequate reliefof biliary obstruction and is associated with low morbidity and mortality. Endoscopic interventional treatment may be considered as an alter-native of palliative biliary operation for the late stage of pancreatic and biliary malignancies.