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目的比较经纤维十二指肠镜逆行胆胰管造影(ERCP)放置胆管内金属支架和塑料支架治疗晚期恶性胆管梗阻的临床效果。方法选取2012年1月—2015年1月黔西南州人民医院收治的ERCP治疗的晚期恶性胆管梗阻患者230例,随机分为金属组和塑料组,各115例。两组患者均给予ERCP内镜下放置胆管内支架治疗,金属组患者使用金属支架,塑料组患者使用塑料支架。患者均术后随访1年,每3个月随访1次。比较两组患者支架置入成功率与胆管再堵塞率及支架置入前后的总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(ALP)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平,观察两组患者术后并发症发生情况。结果两组患者支架置入成功率比较,差异无统计学意义(P>0.05)。金属组患者胆管再堵塞率低于塑料组,差异有统计学意义(P<0.05)。治疗前后两组患者TBIL、DBIL、ALP、AST、ALT水平比较,差异无统计学意义(P>0.05);两组患者治疗后TBIL、DBIL、ALP、AST、ALT水平低于治疗前,差异有统计学意义(P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论 RCP放置胆管内金属支架和塑料支架治疗晚期恶性胆管梗阻的临床效果相当,均可有效改善患者的肝功能,且并发症少,但金属支架胆管再堵塞率低,成本较高。
Objective To compare the clinical effects of intra-biliary metal stent and plastic stent placed in endoscopic retrograde cholangiopancreatography (ERCP) for advanced malignant biliary obstruction. Methods 230 patients with advanced malignant biliary obstruction treated by ERCP in Qianxinan People’s Hospital from January 2012 to January 2015 were randomly divided into metal group and plastic group, 115 cases in each group. ERCP endoscopic biliary stent placement was performed in both groups, with metal stents in the metal group and plastic stents in the plastic group. All patients were followed up for 1 year and followed up every 3 months. The success rate of stent placement, the rate of re-occlusion of bile duct and the total bilirubin (TBIL), direct bilirubin (DBIL), alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured. The postoperative complications of the two groups were observed. Results There was no significant difference in success rate between the two groups (P> 0.05). The occlusion rate of bile duct in the metal group was lower than that in the plastic group, the difference was statistically significant (P <0.05). There was no significant difference in the levels of TBIL, DBIL, ALP, AST and ALT between the two groups before and after treatment (P> 0.05). The levels of TBIL, DBIL, ALP, AST and ALT after treatment in both groups were lower than those before treatment Statistical significance (P <0.05). There was no significant difference in complication rates between the two groups (P> 0.05). Conclusions The clinical effect of RCP placement of biliary stent and plastic stent in the treatment of advanced malignant biliary obstruction is quite good. All of them can effectively improve the liver function of patients with less complications. However, the rate of occlusion of biliary stent with metal stent is lower and the cost is higher.