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目的探讨通过内镜逆行胰胆管造影术(ERCP)联合胆道支架置入治疗恶性梗阻性黄疸患者的临床应用价值。方法本文回顾性分析2011年1月1日—2014年12月31日期间在温州医科大学附属第二医院接受经ERCP途径胆道支架置入的68例失去手术切除机会或拒绝手术的恶性梗阻性黄疸患者,在全麻下行经ERCP途径胆道支架置入,借此重新打开堵塞的胆道,进而达到胆汁的正常引流。结果本研究68例患者中男性46例,女性22例,年龄28~99岁,平均(67.57±12.78)岁,治疗前血清总胆红素值(TBil)为(217.72±125.54)μmol/L,治疗后1周下降至(149.24±126.92)μmol/L,治疗前血清直接胆红素值(DBil)为(126.46±70.69)μmol/L,治疗后1周下降至(75.55±68.66)μmol/L,差异具有统计学意义(P<0.05);治疗前后肝功能其他指标也得到明显降低。其中14例患者减黄效果较差,支架置入后1周黄疸缓解率为79.41%。患者的术后平均生存期为(10.13±10.49)个月。结论经ERCP途径胆道支架置入不仅可以延长患者生存期和改善生活质量,而且具有安全、简便、创伤小、可重复等优点,是一种姑息性治疗恶性梗阻性黄疸的有效方法之一。
Objective To investigate the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) combined with biliary stenting in the treatment of patients with malignant obstructive jaundice. Methods This retrospective analysis of January 1, 2011 - December 31, 2014 at the Second Affiliated Hospital of Wenzhou Medical University received via ERCP pathway into the biliary stents 68 cases of surgical resection lost or refused surgery of malignant obstructive jaundice Patients under general anesthesia ERCP pathway through the biliary stent implantation, to reopen the blocked bile duct, and thus achieve the normal drainage of bile. Results The 68 patients included 46 males and 22 females, ranging in age from 28 to 99 years with an average of (67.57 ± 12.78) years. Serum total bilirubin (TBil) before treatment was (217.72 ± 125.54) μmol / L, The level of direct serum bilirubin (DBil) was (126.46 ± 70.69) μmol / L before treatment and decreased to (75.55 ± 68.66) μmol / L one week after treatment , The difference was statistically significant (P <0.05); before and after treatment other indicators of liver function has also been significantly reduced. Of the 14 patients, the effect of reducing yellow was poor, and the rate of jaundice remission was 79.41% 1 week after stent implantation. The average postoperative survival of patients was (10.13 ± 10.49) months. Conclusion ERCP-based biliary stenting not only prolongs survival and improves quality of life, but also is safe, simple, less invasive and repeatable. It is an effective palliative treatment for malignant obstructive jaundice.