CAJ | 학술논문

目的比较内镜置入可膨式金属胆道支架与手术治疗对恶性梗阻性黄疸患者的疗效及生存期,分析预后影响因素.方法对同期56例内镜置入支架及90例手术的恶性梗阻性黄疽患者资料进行回顾性分析并随访生存情况,比较两组治疗前后血清生化指标及术后远期存活情况.结果支架及手术均可显著降低血清胆红素及胆系酶(P＜0.01),两者在降低总胆红素方面差异无统计学意义.支架组和手术组的中位生存时间分别为340 d和795 d,两组术后3、6、12个月累积生存率分别为82.6％、61.1％、46.4％和97.0％、90.9％、65.4％,两组的累积生存率差异有统计学意义(P＜0.01).原发肿瘤伴转移、高位胆管梗阻的患者,支架组和手术组的生存期相仿.结论内镜下置入支架与手术相比,对恶性梗阻性黄疸患者有同样的退黄效果,而对于延长患者的生存时间无明显作用.对手术无法切除的恶性梗阻性黄疸患者,经内镜置入可膨式金属胆道支架是安全有效的治疗方法.
목적 비교내경치입가팽식금속담도지가여수술치료대악성경조성황달환자적료효급생존기,분석예후영향인소.방법 대동기56례내경치입지가급90례수술적악성경조성황저환자자료진행회고성분석병수방생존정황,비교량조치료전후혈청생화지표급술후원기존활정황.결과 지가급수술균가현저강저혈청담홍소급담계매(P＜0.01),량자재강저총담홍소방면차이무통계학의의.지가조화수술조적중위생존시간분별위340 d화795 d,량조술후3、6、12개월루적생존솔분별위82.6％、61.1％、46.4％화97.0％、90.9％、65.4％,량조적루적생존솔차이유통계학의의(P＜0.01).원발종류반전이、고위담관경조적환자,지가조화수술조적생존기상방.결론 내경하치입지가여수술상비,대악성경조성황달환자유동양적퇴황효과,이대우연장환자적생존시간무명현작용.대수술무법절제적악성경조성황달환자,경내경치입가팽식금속담도지가시안전유효적치료방법.
Objective To compare the efficacy and survival of patients with malignant obstructive jaundice using either endoscopic self-expandable metallic stents or surgery,and to evaluate the compounding factors influencing prognosis.Methods 56 patients with malignant obstructive jaundice treated with endoscopic self-expandable metallic stents (the endoscopic group) were compared with 90 patients who received surgery (the surgery group) during the same study period.Clinical data and survival of the 2 groups of patients were retrospectively analyzed.Results The success rate was 100％ in the endoscopic group.The serum bilirubin,alkaline phosphatase (ALP) and γ-glutamyl transferase (γ-GT) decreased significantly by using either therapeutic endoscopy or surgery (P＜0.01).There was no significant difference between the two groups in the reduction of serum total bilirubin.The mean survival of the endoscopic and surgery groups were 340 d and 795 d respectively.The accumulative survivals of the endoscopic group at 3,6 and 12 months as evaluated by the Kaplan-Meier method were 82.6 ％,61.1％ and 46.6 ％,respectively,and for the surgery group were 97.0％,90.9 ％ and 65.4％ respectively. There was a significant difference in survival between the two groups (P＜0.01).Survival after therapeutic endoscopy was similar to surgery for patients with metastasis and hilar biliary obstruction.Conclusions Self-expandable metallic stents gave similar palliation in the relief of jaundice in patients with malignant biliary obstruction.The stents had no effect on the primary tumor.Therapeutic endoscopy with self-expandable metallic stents is a safe and effective method for the relief of jaundice in patients with obstructive jaundice caused by non-resectable malignant tumors.