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目的比较金属支架与塑料支架(内涵管)置入术治疗恶性胆道梗阻的临床疗效。方法调查广东省3家医院95例实施经皮穿肝胆总管支架置入术的恶性胆道梗阻患者,其中61例置入自膨式金属支架(支架组),34例置入10F塑料内涵管(内涵管组)。所有患者均回访至死亡或至少术后1年。用Kaplan-Meier方法分析比较两组患者的生存及支架开通率。结果支架组的30 d死亡率(6/61,9.8%)低于内涵管组(9/34,26.5%,P<0.05)。支架组30d再阻塞率(15.0%)和并发症发生率(16.4%)均明显低于内涵管组(分别为32.4%和29.4%,P<0.01)。支架组中位开通期(230 d)和中位生存期(224 d)明显长于内涵管组(分别为90和94d,P<0.01)。结论金属支架置入术治疗恶性胆道梗阻临床疗效优于内涵管。
Objective To compare the clinical efficacy of metal stents and plastic stents (implantable tubes) in the treatment of malignant biliary obstruction. Methods Ninety-five patients with malignant biliary obstruction undergoing percutaneous transhepatic biliary stenting were enrolled in three hospitals in Guangdong Province. Of them, 61 were implanted with self-expanding metal stents (stent group) and 34 were implanted with 10F plastic condom Tube group). All patients returned to death or at least 1 year after surgery. The Kaplan-Meier method was used to analyze the survival and stent opening rates in both groups. Results The 30-day mortality rate (6 / 61,9.8%) in the stent group was lower than that in the intubated group (9 / 34,26.5%, P <0.05). The 30-day reocclusion rate (15.0%) and complication rate (16.4%) in the stent group were significantly lower than those in the intubated tube group (32.4% and 29.4%, respectively; P <0.01). Median opening (230 days) and median survival (224 days) were significantly longer in the stent group than those in the intubation group (90 and 94 days, P <0.01, respectively). Conclusion The clinical effect of metal stenting in the treatment of malignant biliary obstruction is better than that of the integrative tube.