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目的探讨胆道内置引流管对恶性胆道梗阻的疗效及影响因素。方法43例恶性胆道梗阻患者先通过内镜下逆行胰胆管造影(ERCP)放置胆道内置引流管,ERCP不成功则通过经皮经肝胆管造影(PTCD)联合ERCP放置胆道内置引流管。观察其操作成功率、退黄效果、并发症发生情况、支架通畅期及患者生存期。结果43例患者中20例均成功通过ERCP置入胆道内置引流管,改行PTCD后联合ERCP再放入胆道内置引流管23例,行2种处理方法均未能成功行胆道外置引流管1例;所有患者术后黄疸明显减退(P<0.01);支架再次阻塞2例,反复发作胆管炎1例,胆漏1例,死亡1例,并发症发生率为11.9%;支架平均通畅期为154 d,患者平均生存期为237 d。结论ERCP或PTCD联合ERCP行胆道内置引流管创伤小,通畅性能好,可作为无法手术切除或不愿手术的恶性胆道梗阻患者的首选治疗方法。
Objective To investigate the curative effect and influencing factors of biliary internal drainage tube on malignant biliary obstruction. Methods Forty - three patients with malignant biliary obstruction underwent endoscopic retrograde cholangiopancreatography (ERCP) with an internal biliary drainage tube. If ERCP was unsuccessful, the biliary drainage tube was placed by percutaneous transhepatic cholangiography (PTCD) combined with. Observe the success rate of operation, jaundice effect, the incidence of complications, stent patency and patient survival. Results Twenty-three of the 43 patients were successfully treated with ERCP by inserting the biliary drainage tube into the biliary duct. After the conversion of PTCD, ERCP and ERCP were placed in the biliary drainage tube. Twenty-three treatments failed to achieve biliary drainage ; All patients had jaundice significantly decreased (P <0.01); stent again blocked in 2 cases, recurrent cholangitis in 1 case, bile leakage in 1 case, 1 patient died, the complication rate was 11.9%; the average stent patency was 154 d, the average survival of patients was 237 days. Conclusions ERCP or PTCD combined with ERCP has the advantages of less invasiveness and good patency of biliary drainage tube. It can be used as the first choice of treatment for patients with malignant biliary obstruction who can not be surgically or reluctantly.