经内镜逆行胰胆管造影胆道金属支架置入治疗不可切除肝外胆道恶性梗阻的效果观察

徐刚

doi:10.3969/j.issn.1001-5256.2018.02.023

经内镜逆行胰胆管造影胆道金属支架置入治疗不可切除肝外胆道恶性梗阻的效果观察

DOI: 10.3969/j.issn.1001-5256.2018.02.023

徐刚

郑州大学第二附属医院消化内科

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- 出版日期: 2018-02-20

Clinical effect of biliary metal stent implantation via endoscopic retrograde cholangiopancreatography in treatment of unresectable malignant extrahepatic biliary obstruction

Xu Gang

Department of Gastroenterology, The Second Affiliated Hospital of Zhengzhou University

摘要

摘要:
目的探讨经内镜逆行胰胆管造影（ERCP）胆道金属支架置入对于肝外胆道恶性梗阻的临床疗效及安全性。方法收集2010年1月-2015年12月郑州大学第二附属医院收治的不可切除性肝外胆道恶性梗阻患者40例。根据手术方法不同分为经皮经肝胆管穿刺引流术（PTCD）组和ERCP组各20例。观察2组患者支架通畅期和生存期、术后临床疗效、术后并发症发生情况、术后住院时间等指标。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验或校正的χ2检验。2组支架通畅期和生存期的比较采用Kaplan-Meier法对数秩检验。结果 ERCP组患者的支架通畅期[（225.6±52.5）d vs（156.3±44.5）d]、生存期[（335.6±42.5）d vs（225.5±42.5）d]较PTCD组均明显延长（t值分别为11.45、10.46,P值均<0.05）。ERCP组患者术后发生腹痛（7例）少于PTCD组（10例）,差异有统计学意义（35.0%vs 50.0%,χ2=9.45,P<0.05）。ERCP组患者术后严重并发症发生率显著低于PTCD组（10.0%vs 30.0%,χ2=7.49,P...
- 胆道疾病 /
- 胰胆管造影术,内窥镜逆行 /
- 治疗结果
Abstract:
Objective To investigate the clinical effect and safety of biliary metal stent implantation via endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of malignant extrahepatic biliary obstruction.Methods A total of 40 patients with unresectable malignant extrahepatic biliary obstruction who were admitted to The Second Affiliated Hospital of Zhengzhou University from January 2010 to December 2015 were enrolled, and according to the surgical method, these patients were divided into percutaneous transhepatic cholangiodrainage (PTCD) group and ERCP group, with 20 patients in each group.The two groups were compared in terms of duration of stent patency, survival time, postoperative clinical outcome, incidence of postoperative complications, and length of postoperative hospital stay.The t-test was used for comparison of continuous data between groups, and the chi-square test or the corrected chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to compare the differences in duration of stent patency and survival time between the two groups via the log-rank test.Results Compared with the PTCD group, the ERCP group had significant increases in duration of stent patency (225.6 ± 52.5 d vs 156.3 ± 44.5 d, t = 11.45, P < 0.05) and survival time (335.6 ± 42.5 d vs 225.5 ±42.5 d, t = 10.46, P < 0.05) .Seven patients in the ERCP group and 10 in the PTCD group experienced abdominal pain after surgery, and there was a significant difference between these two groups (35.0% vs 50.0%, χ2= 9.45, P < 0.05) .Compared with the PTCD group, the ERCP group had significantly lower incidence rate of severe postoperative complications (10.0% vs 30.0%, χ2= 7.49, P < 0.05) and shorter length of hospital stay (12.4 ± 2.5 d vs 19.8 ± 4.0 d, t = 10.67, P < 0.05) .Conclusion Metal stent implantation via ERCP has a similar clinical effect to PTCD in the treatment of malignant extrahepatic biliary obstruction, while compared with PTCD, ERCP allows for longer duration of stent patency and survival time, fewer complications, and a shorter length of hospital stay.Therefore, ERCP has better clinical effect and safety in patients with malignant extrahepatic biliary obstruction.
- bile duct diseases /
- cholangiopancreatography, endoscopic retrograde /
- treatment outcome

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参考文献(15)

[1]CASTRO FA, KOSHIOL J, HSING AW, et al.Biliary tract cancer incidence in the United States-demographic and temporal variations by anatomic site[J].Int J Cancer, 2013, 133 (7) :1664-1671.

[2]BLECHACZ B, KOMUTA M, ROSKAMS T, et al.Clinical diagnosis and staging of cholangiocarcinoma[J].Nat Rev Gastroenterol Hepatol, 2011, 8 (9) :512-522.

[3]DEOLIVEIRA ML, SCHULICK RD, NIMURA Y, et al.New staging system and a registry for perihilar cholangiocarcinoma[J].Hepatology, 2011, 53 (4) :1363-1371.

[4]SIEGEL R, MA J, ZOU Z, et al.Cancer statistics, 2014[J].CA Cancer J Clin, 2014, 64 (1) :9-29.

[5]MOHAMADNEJAD M, DEWITT JM, SHERMAN S, et al.Role of EUS for preoperative evaluation of cholangiocarcinoma:a large single-center experience[J].Gastrointest Endosc, 2011, 73 (1) :71-78.

[6]TELLEZ-AVILA FI, BERNAL-MENDEZ AR, GUERREROVAZQUEZ CG, et al.Diagnostic yield of EUS-guided tissue acquisition as a first-line approach in patients with suspected hilar cholangiocarcinoma[J].Am J Gastroenterol, 2014, 109 (8) :1294-1296.

[7]WEILERT F, BHAT YM, BINMOELLER KF, et al.EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction:results of a prospective, single-blind, comparative study[J].Gastrointest Endosc, 2014, 80 (1) :97-104.

[8]EL CHAFIC AH, DEWITT J, LEBLANC JK, et al.Impact of preoperative endoscopic ultrasound-guided fine needle aspiration on postoperative recurrence and survival in cholangiocarcinoma patients[J].Endoscopy, 2013, 45 (11) :883-889.

[9]TUMMALA P, MUNIGALA S, ELOUBEIDI MA, et al.Patients with obstructive jaundice and biliary stricture±mass lesion on imaging:prevalence of malignancy and potential role of EUS-FNA[J].J Clin Gastroenterol, 2013, 47 (6) :532-537.

[10]KHASHAB MA, FOCKENS P, AL-HADDAD MA.Utility of EUS in patients with indeterminate biliary strictures and suspected extrahepatic cholangiocarcinoma (with videos) [J].Gastrointest Endosc, 2012, 76 (5) :1024-1033.

[11]CAPPELL MS, KILLEEN TC, JURY R.Common bile duct carcinoid mimicking the clinical, EUS, and ERCP findings of cholangiocarcinoma:a rare but potentially curable cause of obstructive jaundice[J].Clin Gastroenterol Hepatol, 2011, 9 (11) :e112-e113.

[12]LEVY MJ, HEIMBACH JK, GORES GJ.Endoscopic ultrasound staging of cholangiocarcinoma[J].Curr Opin Gastroenterol, 2012, 28 (3) :244-252.

[13]ANNUNZIATA S, CALDARELLA C, PIZZUTO DA, et al.Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in the evaluation of the primary tumor in patients with cholangiocarcinoma:a meta-analysis[J].Biomed Res Int, 2014, 2014:247693.

[14]PARK MS, LEE SM.Preoperative 18F-FDG PET-CT maximum standardized uptake value predicts recurrence of biliary tract cancer[J].Anticancer Res, 2014, 34 (5) :2551-2554.

[15]ITO Y, KENMOCHI T, EGAWA T, et al.Clinicopathological features of early distal cholangiocarcinoma[J].Hepatogastroenterology, 2013, 60 (124) :673-677.

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