经ERCP置入胆道金属支架与PTCD治疗老年肝外胆道恶性梗阻患者临床疗效比较
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摘要
目的观察比较经内镜逆行胰胆管造影(ERCP)放置胆道金属支架与经皮肝穿刺胆管引流术(PTCD治疗老年肝外胆道恶性梗阻患者的临床效果。方法 2014年10月～2017年10月我院收治的60例老年肝外胆道恶性梗阻患者,30接受PTCD治疗(对照组),另30例接受经ERCP胆道金属支架置入治疗(观察组)。随访1年。结果术后,观察组支架通畅时间为(225.4±52.6) d,显著长于对照组【(156.7±44.2) d,P<0.05】,住院时间为(12.3±2.4)d,显著短于对照组【(19.9±4.1) d,P<0.05】;观察组血清总胆红素为(110.2±60.1)μmol/L,显著低于对照组【(149.8±64.5)μmol/L,P<0.05】,碱性磷酸酶为(216.8±127.6)IU/L,显著低于对照组【(312.9±149.5) I-U/L,P<0.05】,谷氨酰转肽酶为(196.5±100.5) IU/L,显著低于对照组【(269.8±121.3) IU/L,P<0.05】;观察组并发症发生率为10.0%,显著低于对照组的33.3%(P<0.05);1 a生存率为30.0%,显著高于对照组的10.0%(x~2=3.922,P=0.045)。结论老年肝外胆道恶性梗阻患者接受经ERCP胆道金属支架置入治疗能短期降低黄疸,改善患者的肝功能指标,延长生存期。
Objective To observe the clinical efficacy of biliary stent placement under endosocopic retrograde cholangiopancreatography(ERCP) in the treatment of elderly patients with extrahepatic biliary malignant obstruction. Methods Sixty elderly patients with extrahepatic malignant biliary obstruction were admitted to our hospital between October 2014 and October 2017,30 in control received percutaneous transhepatic cholangiography(PTCD) treatment,while other 30 in observation group received ERCP biliary metal stent implantation. All patients were followed-up for 12 months. Results The stent patency period in the observation group was(225.4±52.6) days,significantly longer than [(156.7 ±44.2) days,P <0.05] in control group,and hospitalization stay was(12.3±2.4) days,significantly shorter than [(19.9±4.1) days,P<0.05] in control group;total serum bilirubin level 2 weeks after operation in the observation group was(110.2 ±60.1) μmol/L,significantly lower than [(149.8 ±64.5)μmol/L,P<0.05],serum alkaline phosphatase level was(216.8±127.6) IU/L,significantly lower than [(312.9±149.5)IU/L,P<0.05],and serum glutamyltransferase level was(196.5 ±100.5) IU/L,significantly lower than[(269.8 ±121.3)IU/L,P <0.05] in the control group;the incidence of post-operational complications was 10.0%,much lower than 33.3%(P<0.05) in the control,and 1-yr survival was 30.0%,much higher than 10.0%(x~2=3.922,P=0.045) in the control. Conclusion The elderly patients with malignant extrahepatic biliary obstruction received ERCP biliary stent implantation might be efficacious in a short-term observation,which could shorten hospitalization stay,and prolong survival.
Objective To observe the clinical efficacy of biliary stent placement under endosocopic retrograde cholangiopancreatography(ERCP) in the treatment of elderly patients with extrahepatic biliary malignant obstruction. Methods Sixty elderly patients with extrahepatic malignant biliary obstruction were admitted to our hospital between October 2014 and October 2017,30 in control received percutaneous transhepatic cholangiography(PTCD) treatment,while other 30 in observation group received ERCP biliary metal stent implantation. All patients were followed-up for 12 months. Results The stent patency period in the observation group was(225.4±52.6) days,significantly longer than [(156.7 ±44.2) days,P <0.05] in control group,and hospitalization stay was(12.3±2.4) days,significantly shorter than [(19.9±4.1) days,P<0.05] in control group;total serum bilirubin level 2 weeks after operation in the observation group was(110.2 ±60.1) μmol/L,significantly lower than [(149.8 ±64.5)μmol/L,P<0.05],serum alkaline phosphatase level was(216.8±127.6) IU/L,significantly lower than [(312.9±149.5)IU/L,P<0.05],and serum glutamyltransferase level was(196.5 ±100.5) IU/L,significantly lower than[(269.8 ±121.3)IU/L,P <0.05] in the control group;the incidence of post-operational complications was 10.0%,much lower than 33.3%(P<0.05) in the control,and 1-yr survival was 30.0%,much higher than 10.0%(x~2=3.922,P=0.045) in the control. Conclusion The elderly patients with malignant extrahepatic biliary obstruction received ERCP biliary stent implantation might be efficacious in a short-term observation,which could shorten hospitalization stay,and prolong survival.
引文
[1]Dong IG,Ko GY,Kim JW,et al.Double-stent system with long duodenal extension for palliative treatment of malignant extrahepatic biliary obstructions:a prospective study.Kor J Radiol,2018,19(2):230-236.
[2]Brioschi V,Rousset N,Ladlow J F.Imaging diagnosis-extrahepatic biliary tract obstruction secondary to a biliary foreign body in a cat.Veter Radiol Ultrasound,2015,55(6):628-631.
[3]Chamberlain RS,Blumgart LH.Carcinoid tumors of the extrahepatic bile duct.A rare cause of malignant biliary obstruction.Cancer,2015,86(10):1959-1965.
[4]王威,夏辉,李兵.不同造影剂剂量行ERCP检查对胆道梗阻患者肝功能指标的影响及疾病预后分析.实用肝脏病杂志,2017,20(5):580-583.
[5]于皆平,沈志祥,罗和生.实用消化病学,2版.北京:科学出版社,2007:566-568.
[6]Shim DJ,Gwon DI,Han K,et al.Percutaneous metallic stent placement for palliative management of malignant biliary hilar obstruction.Kor J Radiol,2018,19(4):597-605.
[7]Davee T,Kukreja K,Glover MT,et al.Tu1494 delayed pancreatitis risk with chemoradiation after metal biliary stent placement for malignant biliary obstruction.Gastrointest Endosc,2017,85(5):649-650.
[8]Walter D,van Boeckel PG,Groenen MJ,et al.Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial.Gastroenterology,2015,149(1):130-138.
[9]Donnan E,Bentrem DJ,Komanduri S,et al.ERCP in potentially resectable malignant biliary obstruction is frequently unsuccessful when performed outside of a comprehensive pancreaticobiliary center.J Surg Oncol,2016,113(6):647-651.
[10]Adam A,Viviane HJ,Bhat Y,et al.Comparison costs of ERCPand MRCP in patients with suspected biliary obstruction based on a randomized trial.Value Health,2015,18(6):767-773.
[11]Jang S,Stevens T,Parsi M,et al.Association of covered metallic stents with cholecystitis and stent migration in malignant biliary stricture.Gastrointest Endosc,2017,87(4):1061-1070.
[12]Lee E,Gwon DI,Ko GY,et al.Percutaneous biliary covered stent insertion in patients with malignant duodenobiliary obstruction.Acta Radiologica,2015,56(2):166-73.
[13]Nakai Y,Matsubara S,Isayama H,et al.Cystic duct patency in EUS-guided gallbladder drainage as a rescue treatment for malignant biliary obstruction.Gastrointest Endosc,2016,83(6):1302-1303.
[14]马海艳.经内镜逆行胰胆管造影支架置入对老年恶性梗阻性黄疸患者的临床疗效和对肝功能及免疫功能的影响.中国内镜杂志,2017,23(8):55-60.
[15]Sakai Y,Iwai T,Shimura K,et al.Safety and efficacy of metallic stent for unresectable distal malignant biliary obstruction in elderly patients.World J Gastroenterol,2018,24(1):69-75.
[16]Wang J,Zhao L,Zhou C,et al.Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for nonresectable malignant biliary obstruction improves stent patency but not survival.Medicine,2016,95(15):1-6.
[17]Will U,Fueldner F,Kern C,et al.EUS-guided bile duct drainage(EUBD)in 95 patients.Ultraschall Der Medizin,2015,36(3):276-283.
[18]陈磊,吴益峰,蒋存兵,等.经ERCP胆道金属支架植入治疗不可切除肝外胆道恶性梗阻的安全性及疗效评价.中国内镜杂志,2018,24(3):27-31.
[19]Bentrem T,David J,Komanduri S,et al.Su1767 ERCP in potentially resectable malignant biliary obstruction remains common and is associated with frequent failed procedures when performed outside of an academic medical center.Gastroenterology,2015,148(4):1143-1144.
[20]Finkelmeier F,Tal A,Ajouaou M,et al.ERCP in elderly patients:increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis.Gastrointest Endosc,2015,82(6):1051-1059.
[2]Brioschi V,Rousset N,Ladlow J F.Imaging diagnosis-extrahepatic biliary tract obstruction secondary to a biliary foreign body in a cat.Veter Radiol Ultrasound,2015,55(6):628-631.
[3]Chamberlain RS,Blumgart LH.Carcinoid tumors of the extrahepatic bile duct.A rare cause of malignant biliary obstruction.Cancer,2015,86(10):1959-1965.
[4]王威,夏辉,李兵.不同造影剂剂量行ERCP检查对胆道梗阻患者肝功能指标的影响及疾病预后分析.实用肝脏病杂志,2017,20(5):580-583.
[5]于皆平,沈志祥,罗和生.实用消化病学,2版.北京:科学出版社,2007:566-568.
[6]Shim DJ,Gwon DI,Han K,et al.Percutaneous metallic stent placement for palliative management of malignant biliary hilar obstruction.Kor J Radiol,2018,19(4):597-605.
[7]Davee T,Kukreja K,Glover MT,et al.Tu1494 delayed pancreatitis risk with chemoradiation after metal biliary stent placement for malignant biliary obstruction.Gastrointest Endosc,2017,85(5):649-650.
[8]Walter D,van Boeckel PG,Groenen MJ,et al.Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial.Gastroenterology,2015,149(1):130-138.
[9]Donnan E,Bentrem DJ,Komanduri S,et al.ERCP in potentially resectable malignant biliary obstruction is frequently unsuccessful when performed outside of a comprehensive pancreaticobiliary center.J Surg Oncol,2016,113(6):647-651.
[10]Adam A,Viviane HJ,Bhat Y,et al.Comparison costs of ERCPand MRCP in patients with suspected biliary obstruction based on a randomized trial.Value Health,2015,18(6):767-773.
[11]Jang S,Stevens T,Parsi M,et al.Association of covered metallic stents with cholecystitis and stent migration in malignant biliary stricture.Gastrointest Endosc,2017,87(4):1061-1070.
[12]Lee E,Gwon DI,Ko GY,et al.Percutaneous biliary covered stent insertion in patients with malignant duodenobiliary obstruction.Acta Radiologica,2015,56(2):166-73.
[13]Nakai Y,Matsubara S,Isayama H,et al.Cystic duct patency in EUS-guided gallbladder drainage as a rescue treatment for malignant biliary obstruction.Gastrointest Endosc,2016,83(6):1302-1303.
[14]马海艳.经内镜逆行胰胆管造影支架置入对老年恶性梗阻性黄疸患者的临床疗效和对肝功能及免疫功能的影响.中国内镜杂志,2017,23(8):55-60.
[15]Sakai Y,Iwai T,Shimura K,et al.Safety and efficacy of metallic stent for unresectable distal malignant biliary obstruction in elderly patients.World J Gastroenterol,2018,24(1):69-75.
[16]Wang J,Zhao L,Zhou C,et al.Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for nonresectable malignant biliary obstruction improves stent patency but not survival.Medicine,2016,95(15):1-6.
[17]Will U,Fueldner F,Kern C,et al.EUS-guided bile duct drainage(EUBD)in 95 patients.Ultraschall Der Medizin,2015,36(3):276-283.
[18]陈磊,吴益峰,蒋存兵,等.经ERCP胆道金属支架植入治疗不可切除肝外胆道恶性梗阻的安全性及疗效评价.中国内镜杂志,2018,24(3):27-31.
[19]Bentrem T,David J,Komanduri S,et al.Su1767 ERCP in potentially resectable malignant biliary obstruction remains common and is associated with frequent failed procedures when performed outside of an academic medical center.Gastroenterology,2015,148(4):1143-1144.
[20]Finkelmeier F,Tal A,Ajouaou M,et al.ERCP in elderly patients:increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis.Gastrointest Endosc,2015,82(6):1051-1059.