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目的:探讨不同方式胆道内支架置入术治疗恶性阻塞性黄疸的临床应用价值、优缺点及选择。方法:回顾分析40例恶性阻塞性黄疸患者的临床资料,其中记忆合金胆道内支架18例经开腹手术置入,经PTCD置入5例,经ERCP置入17例。结果:患者均完成胆道内支架置入达到内引流。支架植入术后胆红素均在第3天下降约80μmol/L;谷草转氨酶、谷丙转氨酶、碱性磷酸酶及谷氨酰转肽酶也在术后第3天开始较术前明显下降(P<0.05)。主要并发症有胆道出血3例,胆管炎8例,多器官衰竭1例;并发症发生率为30.0%,经非手术治疗后大多数恢复。全组中位生存时间为28周,平均生存(33.79±36.83)周。全组围手术期死亡1例,病死率为2.5%。结论:胆道内支架经开腹手术置入、经ERCP置入及经PTCD置入均可有效解除恶性阻塞性黄疸的胆管梗阻,改善肝功能但总并发症发生率较高。
Objective: To investigate the clinical value, advantages, disadvantages and options of different methods of biliary stenting in the treatment of malignant obstructive jaundice. Methods: The clinical data of 40 patients with malignant obstructive jaundice were retrospectively analyzed. Among them, 18 cases were treated with open-heart surgery, 5 cases were treated with PTCD, and 17 cases were treated with ERCP. Results: All patients completed biliary stent implantation to achieve internal drainage. Bilirubin decreased about 80 μmol / L on the third day after stent implantation; aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and glutamyl transpeptidase also decreased significantly from the third day after operation (P <0.05). The main complications were biliary tract bleeding in 3 cases, cholangitis in 8 cases and multiple organ failure in 1 case. The complication rate was 30.0%. Most of the complications were recovered after non-surgical treatment. The overall median survival time was 28 weeks, with an average survival (33.79 ± 36.83) weeks. Perioperative death in the whole group in 1 case, the mortality rate was 2.5%. CONCLUSION: Biliary stents are implanted via laparotomy. ERCP implantation and PTCD insertion can effectively relieve biliary obstruction of malignant obstructive jaundice and improve liver function, but the incidence of total complication is high.