摘要
目的探讨经ERCP与经口胰胆管镜技术行胆管支架置入在高位胆管癌中的疗效。方法回顾性分析2021年1月至2023年9月在南阳市中心医院行胆管支架置入的136例高位胆管癌患者临床资料。根据胆管支架置入方式分为ERCP组(86例)和经口胰胆管镜组(50例)。比较两组患者年龄、相关检验指标、住院天数、术后并发症、肝衰竭发生率、黄疸缓解率、支架材质及通畅率等情况。结果所有患者均成功完成手术。两组在术后肝衰竭发生率、黄疸缓解率、不同材质支架在术后并发症及短期通畅率方面对比,无明显统计学意义(P>0.05)。两组患者术后总的并发症比较,差异有统计学意义(t=12.02,P<0.05),其中术后胆道感染、术后出血相比较,ERCP组分别为26.7%、11.6%,明显高于经口胰胆管镜组的10.0%、2.0%(2=5.42,3.94;P<0.05);两组患者平均住院天数比较,经口胰胆管镜组(10.78±2.17)d<ERCP组(12.91±2.96)d,差异有统计学意义(P<0.05);两组患者手术前后肝功能明显改善,相关检验指标下降明显(P<0.05);塑料支架与金属支架在术后并发症及短期通畅率方面对比,无明显差异(P>0.05),在通畅时间>6个月的情况下,金属支架通畅率明显高于塑料支架(P<0.05)。结论经ERCP与经口胰胆管镜技术置入胆管支架对于缓解高位胆管癌临床症状有效,均可提高患者生存质量。其中经口胰胆管镜技术并发症发生率低、恢复快、优势更大,但花费较高;塑料支架对预期生存时间较短的患者有益,金属支架更适用于预期生存时间较长的患者。
Objective To evaluate the efficacy of two kinds of biliary stent placement in the treatment of high bile duct carcinoma.Methods the clinical data of 136 patients with hilar cholangiocarcinoma who underwent biliary stent implantation in Nanyang Central Hospital from January 2021 to September 2023 were analyzed retrospectively.According to the mode of biliary stent placement,the patients were divided into ERCP group(n=86)and transoral cholangiopancreatoscopy group(n=50).In this study,SPSS26.0 was used for analysis.The age,related test indexes,days of hospitalization,postoperative complications,incidence of liver failure,remission rate of jaundice,stent material and patency rate were observed in the two groups.Results all patients completed the operation successfully.The two groups compared the incidence of postoperative liver failure,postoperative remission rate of jaundice,different material stents,postoperative complications and short-term patency rate,there was no significant statistical significance(P>0.05).There were significant differences in postoperative complications between the two groups(t=12.02,P<0.05).Compared with postoperative biliary tract infection and postoperative bleeding,the postoperative biliary tract infection and postoperative bleeding in ERCP group were 26.7%and 11.6%respectively,which were significantly higher than those in transoral cholangiopancreatoscopy group 10.0%and 2.0%(2=5.42,3.94;P<0.05).Conclusion of the mean hospitalization days between the two patient groups,Transoral cholangioscopy(10.78±2.17)d<ERCP(12.91±2.96)d.Compared with the 7th day after operation,the liver function of the two groups was significantly improved and the related test indexes decreased significantly.There was no significant difference in postoperative complications and short-term patency rate between plastic stent and metal stent(P>0.05).When the patency time was more than 6 months,the patency rate of metal stent was significantly higher than that of plastic stent(P<0.05).Conclusion The placement of bile duct stent by ERCP and Oral choledochoscopy is effective in relieving clinical symptoms of high cholangiocarcinoma and can improve the quality of life of patients.Transoral cholangiopancreatoscopy has low complication rate,faster recovery,greater advantage,but higher cost;plastic stents are beneficial for patients with short expected survival time,and metal stents are more suitable for patients with long expected survival time.
作者
李鹏
宋展
刘驰
戴兵
李琼
LI Peng;SONG Zan;LIU Chi;DAI Bing;LI Qiong(Xinxiang Medical College,Xinxiang 453000,China;General Surgery Department,Nanyang Central Hospital,Nanyang 473000,China)
出处
《现代消化及介入诊疗》
2024年第3期270-273,280,共5页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
河南省医学科技攻关联合共建项目(242102310347)
南阳市医学科技攻关项目(23KJGG128)。
关键词
胆管肿瘤
高位胆管癌
胰胆管镜
内镜下逆行胰胆管造影
胆道支架
Bile duct tumor,hilar cholangiocarcinoma
Pancreatic cholangioscopy
endoscopic retrograde cholangianc-reatography
bile duct stent
