摘要
目的比较内镜置入可膨式金属胆道支架与手术治疗对恶性梗阻性黄疸患者的疗效及生存期，分析预后影响因素。方法对同期56例内镜置入支架及90例手术的恶性梗阻性黄疸患者资料进行回顾性分析并随访生存情况，比较两组治疗前后血清生化指标及术后远期存活情况。结果支架及手术均可显著降低血清胆红素及胆系酶（P〈o．01），两者在降低总胆红素方面差异无统计学意义。支架组和手术组的中位生存时间分别为340d和795d，两组术后3、6、12个月累积生存率分别为82．6％、61．1％、46．4％和97．0％、90．9％、65．4％，两组的累积生存率差异有统计学意义（P〈0．01）。原发肿瘤伴转移、高位胆管梗阻的患者，支架组和手术组的生存期相仿。结论内镜下置入支架与手术相比，对恶性梗阻性黄疸患者有同样的退黄效果，而对于延长患者的生存时间无明显作用。对手术无法切除的恶性梗阻性黄疸患者，经内镜置入可膨式金属胆道支架是安全有效的治疗方法。
Objective To compare the efficacy and survival of patients with malignant obstruc- tive jaundice using either endoscopic self-expandable metallic stents or surgery, and to evaluate the compounding factors influencing prognosis. Methods 56 patients with malignant obstructive jaundice treated with endoscopic self-expandable metallic stents （the endoscopic group） were compared with 90 patients who received surgery （the surgery group） during the same study period. Clinical data and sur- vival of the 2 groups of patients were retrospectively analyzed. Results The success rate was 100% in the endoscopic group. The serum bilirubin, alkaline phosphatase （_ALP） and 7-glutamyl transferase （y-GT） decreased significantly by using either therapeutic endoscopy or surgery （P^0.01）. There was no significant difference between the two groups in the reduction of serum total bilirubin. The mean survival of the endoscopic and surgery groups were 340 d and 795 d respectively. The accumulative survivals of the endoscopic group at 3, 6 and 12 months as evaluated by the Kaplan-Meier method were 82.6 %, 61. 1 G and 46.6 %, respectively, and for the surgery group were 97.0 %, 90. 9 % and 65.4% respectively. There was a significant difference in survival between the two groups （P^0.01）. Survival after therapeutic endoscopy was similar to surgery for patients with metastasis and hilar biliary obstruction. Conclusions Self-expandable metallic stents gave similar palliation in the relief of jaundice in patients with malignant biliary obstruction. The stents had no effect on the prima- ry tumor. Therapeutic endoscopy with self-expandable metallic stents is a safe and effective method for the relief of jaundice in patients with obstructive jaundice caused by non resectable malignant tumors.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2012年第2期118-122,共5页
Chinese Journal of Hepatobiliary Surgery
关键词
恶性梗阻性黄疸
内镜
金属支架
手术
Malignant obstructive jaundicel Endoscopic
Metallic stent
Operation
