内镜下逆行胰胆管造影术治疗胰腺癌导致的梗阻性黄疸的临床疗效
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摘要
目的评估内镜下逆行胰胆管造影术(ERCP)对胰腺癌导致的梗阻性黄疸的临床疗效。方法对南京医科大学附属苏州市立医院2014—2017年收治的30例胰腺癌合并梗阻性黄疸患者实行ERCP引流治疗,观察患者治疗前后总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(γ-GT)水平的变化情况及临床效果。结果 30例患者ERCP引流治疗成功28例,内镜下治疗成功率为93.3%(28/30)。28例ERCP引流成功患者显效19例,有效7例,无效2例,治疗总有效率为92.9%(26/28)。术后1周TBIL、DBIL、AKP、γ-GT水平较术前均显著下降(P<0.05),无消化道大出血、胃肠道穿孔等严重致死性并发症。术后随访1年,2例患者出现支架内梗阻,再次行ERCP放置支架;至随访结束,28例ERCP引流成功患者术后生存期46～824 d,中位生存期187 d。结论 ERCP引流治疗恶性梗阻性黄疸具有创伤小、并发症发生率低、可持久引流胆汁的优点;能显著改善患者临床症状、提高患者生活质量并延长生存期,是一种安全有效的治疗方法。
Objective To evaluate the effect of endoscopic retrograde cholangiopancreatography(ERCP) on obstructive jaundice caused by pancreatic cancer.Methods Thirty patients with pancreatic cancer and obstructive jaundice were treated with ERCP drainage in Suzhou Municipal Hospital Affiliated to Nanjing Medical University between 2014-2017.The levels of total bilirubin(TBIL),direct bilirubin(DBIL),alkaline phosphatase(AKP) and γ-glutamyl transpeptidase(γ-GT) were observed before and after treatment.Results Among the 30 patients,28(93.3%) successfully completed ERCP drainage.The treatment was remarkably effective in 19 patients,moderately effective in 7 patients,and ineffective in 2 patients.The total effective rate was 92.9%(26/28).Compared with preoperative levels,the TBIL,DBIL,AKP and γ-GT decreased 1 week after treatment(P<0.05).No patients had severe complications,such as gastrointestinal bleeding and gastrointestinal perforation.During 1-year follow-up,2 patients had stent obstruction and received ERCP again for stent implantation.The median survival time for the 28 patients who underwent successful ERCP drainage was 187 days(range,46 to 824 days).Conclusion ERCP drainage,as a safe and effective treatment for malignant obstructive jaundice,is associated with small trauma,low incidence of complications and durable biliary drainage.In addition,ERCP drainage can relieve clinical symptoms,improve quality of life and prolong survival in pancreatic cancer patients with obstructive jaundice.
Objective To evaluate the effect of endoscopic retrograde cholangiopancreatography(ERCP) on obstructive jaundice caused by pancreatic cancer.Methods Thirty patients with pancreatic cancer and obstructive jaundice were treated with ERCP drainage in Suzhou Municipal Hospital Affiliated to Nanjing Medical University between 2014-2017.The levels of total bilirubin(TBIL),direct bilirubin(DBIL),alkaline phosphatase(AKP) and γ-glutamyl transpeptidase(γ-GT) were observed before and after treatment.Results Among the 30 patients,28(93.3%) successfully completed ERCP drainage.The treatment was remarkably effective in 19 patients,moderately effective in 7 patients,and ineffective in 2 patients.The total effective rate was 92.9%(26/28).Compared with preoperative levels,the TBIL,DBIL,AKP and γ-GT decreased 1 week after treatment(P<0.05).No patients had severe complications,such as gastrointestinal bleeding and gastrointestinal perforation.During 1-year follow-up,2 patients had stent obstruction and received ERCP again for stent implantation.The median survival time for the 28 patients who underwent successful ERCP drainage was 187 days(range,46 to 824 days).Conclusion ERCP drainage,as a safe and effective treatment for malignant obstructive jaundice,is associated with small trauma,low incidence of complications and durable biliary drainage.In addition,ERCP drainage can relieve clinical symptoms,improve quality of life and prolong survival in pancreatic cancer patients with obstructive jaundice.
引文
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[3] KRUSE E J.Palliation in pancreatic cancer[J].Surg Clin North Am,2010,90:355-364.
[4] COTE G A,SHERMAN S.Endoscopic palliation of pancreatic cancer[J].Cancer J,2012,18:584-590.
[5] MOSS A C,MORRIS E,MAC MATHUNA P.Palliative biliary stents for obstructing pancreatic carcinoma[J].Cochrane Database Syst Rev,2006,25(1):CD004200.
[6] GE P S,HAMERSKI C M,WATSON R R,et al.Plastic biliary stent patency in patients with locally advanced pancreatic adenocarcinoma receiving downstaging chemotherapy[J].Gastrointest Endosc,2015,81:360-366.
[7] WALTER D,VAN BOECKEL P G,GROENEN M J,et al.Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial[J].Gastroenterology,2015,149:130-138.
[8] TOL J A,VAN HOOFT J E,TIMMER R,et al.Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer[J].Gut,2016,65(12):1981-1987.
[9] LEE J H,KRISHNA S G,SINGH A,et al.Comparison of the utility of covered metal stents versus uncovered metal stents inthe management of malignant biliary strictures in 749 patients[J].Gastrointest Endosc,2013,78:312-324.