经ERCP置入胆道金属支架与PTCD治疗老年肝外胆道恶性梗阻患者临床疗效比较*

doi:10.3969/j.issn.1672-5069.2019.02.031

摘要/Abstract

摘要： 目的观察比较经内镜逆行胰胆管造影（ERCP）放置胆道金属支架与经皮肝穿刺胆管引流术（PTCD）治疗老年肝外胆道恶性梗阻患者的临床效果。方法 2014年10月~2017年10月我院收治的60例老年肝外胆道恶性梗阻患者,30接受PTCD治疗（对照组）,另30例接受经ERCP胆道金属支架置入治疗（观察组）。随访1年。结果术后,观察组支架通畅时间为（225.4±52.6） d,显著长于对照组【（156.7±44.2） d,P<0.05】,住院时间为（12.3±2.4）d,显著短于对照组【（19.9±4.1） d,P<0.05】;观察组血清总胆红素为（110.2±60.1） μmol/L,显著低于对照组【（149.8±64.5） μmol/L,P<0.05】,碱性磷酸酶为（216.8±127.6）IU/L,显著低于对照组【（312.9±149.5） IU/L,P<0.05】,谷氨酰转肽酶为（196.5±100.5） IU/L,显著低于对照组【（269.8±121.3） IU/L,P<0.05】;观察组并发症发生率为10.0%,显著低于对照组的33.3%（P<0.05）;1 a生存率为30.0%,显著高于对照组的10.0%（x²=3.922,P=0.045）。结论老年肝外胆道恶性梗阻患者接受经ERCP胆道金属支架置入治疗能短期降低黄疸,改善患者的肝功能指标,延长生存期。

关键词: 肝外胆道恶性梗阻, 经内镜逆行胰胆管造影, 经皮肝穿刺胆管引流术, 老年人, 治疗

Abstract: Objective To observe the clinical efficacy of biliary stent placement under endosocopic retrograde cholangiopancreatography （ERCP） in the treatment of elderly patients with extrahepatic biliary malignant obstruction. Methods Sixty elderly patients with extrahepatic malignant biliary obstruction were admitted to our hospital between October 2014 and October 2017,30 in control received percutaneous transhepatic cholangiography （PTCD） treatment,while other 30 in observation group received ERCP biliary metal stent implantation. All patients were followed-up for 12 months. Results The stent patency period in the observation group was（225.4±52.6） days,significantly longer than[（156.7±44.2） days,P<0.05] in control group,and hospitalization stay was （12.3±2.4） days,significantly shorter than [（19.9±4.1） days,P<0.05] in control group;total serum bilirubin level 2 weeks after operation in the observation group was（110.2±60.1） μmol/L,significantly lower than[（149.8±64.5） μmol/L,P<0.05],serum alkaline phosphatase level was （216.8±127.6） IU/L,significantly lower than [（312.9±149.5） IU/L,P<0.05],and serum glutamyltransferase level was（196.5 ±100.5） IU/L,significantly lower than[（269.8 ±121.3） IU/L,P<0.05] in the control group;the incidence of post-operational complications was 10.0%,much lower than 33.3% （P<0.05） in the control,and 1-yr survival was 30.0%,much higher than 10.0% （x²=3.922,P=0.045） in the control. Conclusion The elderly patients with malignant extrahepatic biliary obstruction received ERCP biliary stent implantation might be efficacious in a short-term observation,which could shorten hospitalization stay,and prolong survival.

Key words: Malignant extrahepatic biliary obstruction, Endoscopic retrograde cholangiopancreatography, Percutaneous transhepatic biliary drainage, Elderly, Therapy

许哲,王珍,李焕祥,陈志才,邵子力. 经ERCP置入胆道金属支架与PTCD治疗老年肝外胆道恶性梗阻患者临床疗效比较^*[J]. 实用肝脏病杂志, 2019, 22(2): 276-279.

Xu Zhe, Wang Zhen, Li Huanxiang, Chen Zhicai, Shao Zili. Clinical observation of biliary stent placement under ERCP in the treatment of elderly patients with extrahepatic biliary malignant obstruction[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(2): 276-279.

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经ERCP置入胆道金属支架与PTCD治疗老年肝外胆道恶性梗阻患者临床疗效比较^*

Clinical observation of biliary stent placement under ERCP in the treatment of elderly patients with extrahepatic biliary malignant obstruction

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