文章摘要
吴莉莉,覃刚,朱鹏,朱季香.鼻胆引流管经内镜剪断后残端用于治疗胆管癌相关恶性胆管梗阻60例[J].中国临床保健杂志,2020,23(5):644-648.
鼻胆引流管经内镜剪断后残端用于治疗胆管癌相关恶性胆管梗阻60例
Clinical research of endoscopic cutting and indwelling nasobiliary drainage tube used for cholangiocarcinoma-related malignant biliary obstruction
投稿时间:2019-12-11  
DOI:10.3969/J.issn.1672-6790.2020.05.017
中文关键词: 胆管肿瘤  胆管梗阻  内窥镜检查,消化系统  胰胆管造影术,内窥镜逆行  支架
英文关键词: Bile duct neoplasms  Bile duct obstructions  Endoscopy,digestive system  Cholangiopancreatography,Endoscopic retrograde  Stents 〖FL
基金项目:四川省卫生和计划生育委员会科研课题(18PJ396);四川省医学重点学科(实验室)建设项目(2018-53-47)
作者单位E-mail
吴莉莉 四川遂宁市第一人民医院消化内科,629000 505562607@qq.com 
覃刚 四川遂宁市第一人民医院消化内科,629000  
朱鹏 四川遂宁市第一人民医院消化内科,629000  
朱季香 四川遂宁市第一人民医院消化内科,629000  
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中文摘要:
      目的 探讨经内镜剪断并留置鼻胆引流管用于治疗恶性胆管狭窄的临床疗效及安全性。方法 纳入2016年1月至2018年2月在遂宁市第一人民医院住院的因晚期胆管癌所致恶性胆管狭窄的患者114例,根据治疗方法分为鼻胆引流管剪断留置组(剪断留置组)(n=60)及支架组(n=54),所有患者均在ERCP下使用鼻胆管外置引流,待胆汁引流清澈后,剪断留置组直接在内镜下剪断并留置部分鼻胆管在胆道内,而支架组在取出鼻胆管后再行ERCP植入塑料支架。观察两组患者治疗相关指标,常规随访观察近远期疗效及安全性。结果 与支架组相比,剪断留置组治疗操作时间及治疗费用显著降低(P<0.05)。支架组中2例(3.7%)患者在取出鼻胆管后因ERCP时导丝插入困难需要再次切开十二指肠乳头。所有患者生存时间为3~9个月,剪断留置组术后生存时间与对照组差异无统计学意义。剪断留置组中,1例(1.7%)发生胆管炎;支架组中,1例(1.8%)同时发生胆道出血及胆管炎,1例(1.8%)发生胆管炎,3例(5.6%)出现了支架移位(经内镜取出)。随访至4周时,剪断留置组与支架组相比,在总胆红素(TBIL)、直接胆红素(DBIL)、总胆汁酸(TBA)及瘙痒评分方面差异无统计学意义。随访至12周时,剪断留置组TBIL、DBIL及TBA均显著低于支架组,差异有统计学意义(P<0.05)。结论 经内镜剪断并留置鼻胆引流管用于治疗胆管癌相关恶性胆道梗阻具有较植入塑料支架更好的效果,可作为患者姑息治疗及改善生活质量的候选方法。
英文摘要:
      Objective To investigate the clinical efficacy and safety of endoscopic cutting and indwelling nasobiliary drainage tube for cholangiocarcinoma-related malignant biliary obstruction.Methods A total of 114 patients with advanced cholangiocarcinoma-related malignant biliary obstruction from January 2016 to February 2018 were enrolled.All patients were divided into nasobiliary drainage tube cut-indwell group (cut-indwell group) (n=60) and plastic stent group (n=54).Nasobiliary drainage tube was used for extenal drainage in all patients until the jaundice was improved significantly.The nasobiliary drainage duct was directly cutted and indwelled in the biliary tract under the endoscope in cut-indwell group,and nasobiliary drainage tube was taken out and the plastic stent was implanted in plastic stent group.All the patinets were followed up.Results Compared with plastic stent group,the operation time and cost in cut-indwell group were significantly decreased (P<0.05).Two (3.7%) patients in the plastic stent group were required re-incision the duodenal papilla due to difficulty in guiding insertion during ERCP after removing the nasobiliary drainage duct.The survival time of all patients was 3-9 months,and there was no significant difference of postoperative survival time between cut-indwell group and plastic stent group.In cut-indwell group,1 (1.7%) developed cholangitis.In plastic stent group,1 (1.8%) developed biliary hemorrhage and cholangitis,1 (1.8%) developed cholangitis,and 3 (5.6%) developed plastic stent displacement (solved by endoscopic removal).After 4 weeks,there were no significant differences in TBIL,DBIL,TBA and pruritus score between cut-indwell group and stent group.After 12 weeks,TBIL,DBIL and TBA in cut-indwell group were significantly lower than those in plastic stent group.Conclusion The clinical efficacy and safety of endoscopic nasobiliary drainage tube cutted and indwelled for cholangiocarcinoma-related malignant biliary obstruction is superior to the plastic stent,which it can be used as a candidate palliative treatment.
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