CAJ | 학술논문

目的：探讨经内镜放置胆管金属支架联合鼻胆管引流对恶性胆管梗阻的治疗效果。方法115例失去手术机会的恶性胆管梗阻患者行经内镜逆行胰胆管造影下放置胆管支架,其中48例行胆管塑料支架引流术,30例行胆管金属支架引流术,37例行胆管金属支架联合鼻胆管引流术；分析各组引流效果、成功率、早期并发症和胆管再堵塞发生情况。结果塑料支架组、金属支架组及金属支架联合鼻胆管组的谷丙转氨酶( ALT)、总胆红素( TBIL)、直接胆红素( DBIL)和碱性磷酸酶( AKP)在手术后均有明显降低(P<0.05)；手术后1周金属支架联合鼻胆管组的TBIL和DBIL明显低于塑料支架组、金属支架组(P<0.05),塑料支架组和金属支架组相比,差异无统计学意义(P>0.05)；术后3个月内金属支架组和金属支架联合鼻胆管组再堵塞的发生率明显低于塑料支架组(P<0.05),金属支架组和金属支架联合鼻胆管组相比,差异无统计学意义(P>0.05)；塑料支架组的手术成功率与金属支架组及金属支架联合鼻胆管组相比,差异无统计学意义(P>0.05),塑料支架组的早期并发症发生率明显高于金属支架联合鼻胆管组,差异有统计学意义(P<0.05)。结论经内镜逆行胰胆管造影下放置胆管金属支架联合鼻胆管对于恶性胆管梗阻有确切的引流效果。
목적：탐토경내경방치담관금속지가연합비담관인류대악성담관경조적치료효과。방법115례실거수술궤회적악성담관경조환자행경내경역행이담관조영하방치담관지가,기중48례행담관소료지가인류술,30례행담관금속지가인류술,37례행담관금속지가연합비담관인류술；분석각조인류효과、성공솔、조기병발증화담관재도새발생정황。결과소료지가조、금속지가조급금속지가연합비담관조적곡병전안매( ALT)、총담홍소( TBIL)、직접담홍소( DBIL)화감성린산매( AKP)재수술후균유명현강저(P<0.05)；수술후1주금속지가연합비담관조적TBIL화DBIL명현저우소료지가조、금속지가조(P<0.05),소료지가조화금속지가조상비,차이무통계학의의(P>0.05)；술후3개월내금속지가조화금속지가연합비담관조재도새적발생솔명현저우소료지가조(P<0.05),금속지가조화금속지가연합비담관조상비,차이무통계학의의(P>0.05)；소료지가조적수술성공솔여금속지가조급금속지가연합비담관조상비,차이무통계학의의(P>0.05),소료지가조적조기병발증발생솔명현고우금속지가연합비담관조,차이유통계학의의(P<0.05)。결론경내경역행이담관조영하방치담관금속지가연합비담관대우악성담관경조유학절적인류효과。
Objective To evaluate the effect of biliary mental stent drainage combined with endoscopic naso-biliary drainage in the treatment of malignant biliary obstruction. Methods One hundred and thirteen patients with maligmant biliary obstruction who had lost the chance for surgery, were treated with biliary stent through endoscopic retrograde cholangiopancreatography:48 patients were treated with endoscopic retrograde biliary drainage with plastic stent, 30 pa-tients were treated with endoscopic retrograde biliary drainage with mental stent, and 37 patients were treated with endo-scopic metal stent drainage combined with naso-biliary drainage. Results The levels of ALT, TBIL, DBIL and AKP of pre-stenting were much higher than that of post-stenting ( P<0 . 05 ) . The levels of TBIL and DBIL of post-stenting for a week of metal sent drainage combined with naso-biliary drainage group were much lower than that of plastic stent group and mental stent group ( P<0 . 05 ) , but there was no significant difference between plastic stent group and metal stent group ( P>0 . 05 ) . The re-blockage rates of metal stent group and metal stent drainage combined with naso-biliary drainage group three months after surgey were much lower than plastic stent group ( P<0 . 05 ) , but there was no differ-ence between metal stent group and metal stent drainage combined with naso-biliary drainage group ( P>0 . 05 ) . There was no difference of successful rate between plastic stent group and metal stent group and metal stent drainage combined with naso-biliary drainage group ( P>0 . 05 ) . Early complication of plastic stent group was much higher than that of met-al stent drainage combined with naso-biliary drainage group ( P<0 . 05 ) . Conclusion The metal stent drainage com-bined with naso-biliary drainage insertion through endoscopic retrograde cholangiopancreatography is effective on malig-nant biliary obstruction.