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目的 :探讨开腹手术放置胆道支架与内镜下支架置入在恶性梗阻性黄疸患者临床治疗中的应用价值及适应症选择。方法 :回顾分析35例不能根治切除的恶性梗阻性黄疸患者采用金属记忆合金胆道内撑支架经开腹手术置入(n=23)、经ERCP置入(n=12)完成胆汁内引流,比较手术前后肝功能变化情况。结果 :所有患者均完成胆管末端支架置入达到内引流的目的。支架置入术后胆红素均在术后第1周下降约100μmol/L;术后第2周胆红素仍有继续下降;谷草转氨酶、谷丙转氨酶、碱性磷酸酶及谷氨酰转肽酶在术后第1周开始较术前明显下降。主要并发症有胆管炎2例,胰腺炎2例,胆道出血3例。结论 :胆道支架经开腹手术置入与经ERCP置入均可有效解除恶性梗阻性黄疸患者胆管梗阻,改善肝功能,提高患者生活质量,延长生存时间。临床根据病情选择合适的胆道支架置入方式,达到个体化治疗,以提高胆道支架置入的安全性、有效性。
Objective: To investigate the clinical value and indications for the treatment of patients with malignant obstructive jaundice after laparotomy placement of biliary stents and endoscopic stents. Methods: Thirty-five patients with malignant obstructive jaundice who underwent radical resection were enrolled in this study. Metal memory alloy biliary stent was implanted laparotomy (n = 23), and biliary drainage was performed by ERCP (n = 12) Changes in liver function before and after surgery. Results: All patients completed the endoscopic stent placement to achieve the goal of internal drainage. Bilirubin was decreased by about 100 μmol / L in the first week after stent implantation. The level of bilirubin was still decreased in the second week after operation. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and glutamyl transferase Peptidase in the first week after surgery significantly decreased compared with preoperative. The main complications were cholangitis in 2 cases, pancreatitis in 2 cases and biliary tract bleeding in 3 cases. Conclusion: Biliary stents can be effectively relieved biliary obstruction, improve liver function, improve quality of life and prolong survival time of patients with malignant obstructive jaundice after laparotomy and ERCP implantation. According to the clinical choice of appropriate biliary stent placement, to individualized treatment to improve the safety and effectiveness of biliary stent placement.