CAJ | 학술논문

目的：探讨恶性梗阻性黄疸胆道支架置入的临床疗效及并发症的发病原因及相应的处理方法。方法：我院2009-01~2011-01的80例恶性梗阻性黄疸病人,经逆行胰胆管造影并胆道支架置入术进行介入治疗。术前术后检测血常规、TBil、DBil、GGT(γ-谷氨酰转移酶)、血清中糖抗原19-9(CA 19-9)。记录临床症状的变化及并发症,术后常规随访,观察各种并发症的发生情况并给予针对性的处理。结果：病人1次支架置入成功数为74例(92.5%)。有4例病人行2次支架置入成功,2例失败。病人的黄疸消失时间(6.1依1.5)d,皮肤瘙痒消失时间(3.0依0.3)d。术后5例并发胆道出血,未有病人出现感染。治疗后血清总胆红素、GGT、CA 19-9均呈下降趋势,病人在治疗前后的血清总胆红素、GGT、CA 19-9差异有统计学意义(P<0.05),治疗后3d和1wk的血清总胆红素值显著低。治疗后随访6mo~2a,平均(12.4依6.3)mo,半年内死亡29例,半a至1a死亡7例,1a至1a半死亡10例,1a半至2a死亡5例。其余29例病人随访至今均存活。有2例病人出现胆管炎,并发症发生率为2.3%。未有病人出现气胸、导管脱位、胆汁性腹膜炎等并发症。结论：ERCP并胆道支架置入术治疗恶性梗阻性黄疸,可明显延长恶性梗阻性黄疸病人的生存时间,是一种相对合理的选择。通过对各种并发症的发生原因进行分析,积极防治并发症,可提高病人的生存时间,改善其生命质量。
목적：탐토악성경조성황달담도지가치입적림상료효급병발증적발병원인급상응적처리방법。방법：아원2009-01~2011-01적80례악성경조성황달병인,경역행이담관조영병담도지가치입술진행개입치료。술전술후검측혈상규、TBil、DBil、GGT(γ-곡안선전이매)、혈청중당항원19-9(CA 19-9)。기록림상증상적변화급병발증,술후상규수방,관찰각충병발증적발생정황병급여침대성적처리。결과：병인1차지가치입성공수위74례(92.5%)。유4례병인행2차지가치입성공,2례실패。병인적황달소실시간(6.1의1.5)d,피부소양소실시간(3.0의0.3)d。술후5례병발담도출혈,미유병인출현감염。치료후혈청총담홍소、GGT、CA 19-9균정하강추세,병인재치료전후적혈청총담홍소、GGT、CA 19-9차이유통계학의의(P<0.05),치료후3d화1wk적혈청총담홍소치현저저。치료후수방6mo~2a,평균(12.4의6.3)mo,반년내사망29례,반a지1a사망7례,1a지1a반사망10례,1a반지2a사망5례。기여29례병인수방지금균존활。유2례병인출현담관염,병발증발생솔위2.3%。미유병인출현기흉、도관탈위、담즙성복막염등병발증。결론：ERCP병담도지가치입술치료악성경조성황달,가명현연장악성경조성황달병인적생존시간,시일충상대합리적선택。통과대각충병발증적발생원인진행분석,적겁방치병발증,가제고병인적생존시간,개선기생명질량。
Objective:To discuss clinical efficacy of biliary stent placement in the treatment of malignant obstructive jaundice, and the causes of the complications and relative treatment method. Methods:80 cases of malignant obstructive jaundice patients in our hospital from 2009 January to 2011 January were treated with endoscopic retrograde cholangiopancreatography and biliary stent for interventional therapy,in addition to anti-infection,hemostasis and symptomatic treatment. Preoperative and postoperative blood routine, TBil, DBil, GGT ( gamma glutamyl transferase ) , serum carbohydrate antigen 19-9(CA 19-9),GGT(gamma glutamyl transferase)were measured. The changes of clinical symptoms and complications were recorded, various complications were observed and given targeted treatment. Results:74 patients had successful stent implantation at one times(92. 5%). There were 4patients with 2 stents and successfully treated and 2 patients failed. The jaundice disappearance time was( 6. 1±1. 5 ) d, skin itching disappeared time was ( 3. 0±0. 3 ) d. After operation 5 cases had complications with biliary tract bleeding,no infection occurred in patients. After treatment,serum total bilirubin,GGT,CA 19-9 were decreased,with statistical significance(P<0. 05). Serum total bilirubin after 3 d and 1 weeks of the treatment were significantly lower. Follow-up time was 6months to 2 years, the averaged time was(12. 4±6. 3)months. 29 patients died within six months,half a year with 1 years, 7 cases with half to 1 years,10 cases with 1 and 1. 5 years,5 cases with 1. 5 to 2 years. The rest of the patients were followed-up and survived. 2 cases had cholangitis,and the accurance rate of complication was 2. 3%. Pneumothorax, catheter dislocation and bile peritonitis were observed in no of these patients. Conclusion:ERCP combined with biliary stent for malignant obstructive jaundice can obviously prolong the survival of patients with malignant obstructive jaundice, and it is a relatively reasonable choice. Analysis of complications causes,active prevention of complications can improve the survival time of patients,and improve their quality of life.