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目的探讨ERCP下胆道金属网眼支架置入及支架内覆膜支架再次置入在恶性梗阻性黄疸中的治疗价值。方法回顾性分析并总结2006年7月至2010年8月收治的67例接受ERCP下金属网眼支架置入治疗的恶性梗阻性黄疸患者和8例支架内再次金属覆膜支架置入患者的临床资料。结果金属网眼支架置入手术成功率95.5%;术后7 d总胆红素由(293.2±99.4)μmol/L降至(93.3±48.4)μmol/L,直接胆红素由(157.5±56.2)μmol/L降至(47.2±23.4)μmol/L,二者水平均较术前显著下降(P<0.05);患者生活质量得到提高,生存期延长,最长的1例达到了29个月(至今仍存活),中位生存时间为11.7个月;8例支架内再次金属覆膜支架置入全部成功,1例术后出现胆管炎;无其他严重并发症发生。结论 ERCP下金属支架置入对于晚期、高龄的恶性梗阻性黄疸患者是一种安全、微创、有效的治疗方法;对肝门部胆管癌患者将支架置入右肝管是延长生存期的重要措施;当支架内发生阻塞时以金属覆膜支架在原支架内再次置入为宜。
Objective To investigate the therapeutic value of ERCP under the implantation of biliary metal mesh stent and stent-graft in malignant obstructive jaundice. Methods The clinical data of 67 patients with malignant obstructive jaundice who underwent metal mesh stent placement in ERCP and 8 patients who underwent metal stent-graft in our hospital from July 2006 to August 2010 were retrospectively analyzed and summarized. . Results The success rate of metal mesh stent implantation was 95.5%. The total bilirubin decreased from (293.2 ± 99.4) μmol / L to (93.3 ± 48.4) μmol / L and the direct bilirubin from (157.5 ± 56.2) (47.2 ± 23.4) μmol / L, both of which were significantly lower than those before surgery (P <0.05). Patients’ quality of life improved and their survival time prolonged. One of the longest cases reached 29 months And still survived till now). The median survival time was 11.7 months. All the stent placement was successful in 8 cases, and cholangitis occurred in 1 case. No other serious complications occurred. Conclusions Metal stent implantation in ERCP is a safe, minimally invasive and effective treatment for patients with advanced and advanced malignant obstructive jaundice. Inserting the stent into the right hepatic duct in patients with hilar cholangiocarcinoma is important for prolonging survival Measures; when the stent occlusion to metal stent in the original stent stent placement is appropriate.