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目的比较经内镜同期置入双侧金属支架或双侧塑料支架治疗肝门部恶性胆道梗阻(MHBO)的疗效及安全性。方法选取2007年5月至2011年12月需要进行双侧胆道引流的142例MHBO患者,其中32例采用双侧金属支架胆道引流(双金属支架组),110例采用双侧塑料支架胆道引流(双塑料支架组),统计内镜操作成功率、术后减黄有效率、内镜逆行胆胰管造影(ERCP)术后并发症及支架通畅期。结果全组操作成功率为100%。双金属支架组和双塑料支架组术后减黄有效率分别为96.9%(31/32)和88.2%(97/110),组间差异无统计学意义(P>0.05)。双金属支架组和双塑料支架组ERCP术后分别出现2例和6例胆管炎,经抗炎对症、更换支架或置入鼻胆管处理后症状缓解;双塑料支架组出现2例支架部分滑脱。两组均未发生胰腺炎、消化道出血、穿孔及ERCP相关性死亡病例。至研究终点,双金属支架组和双塑料支架组分别有2例和4例因其他原因死亡,死亡时胆道内支架均通畅;双金属支架组和双塑料支架组分别有8例和29例再发梗阻性黄疸,予以重新置入或更换塑料支架处理。两组ERCP术后并发症发生率差异无统计学意义(P>0.05)。双金属支架组的中位通畅期为(248.53±138.61)d,双塑料支架组的中位通畅期为(101.76±38.53)d,经Log-rank检验差异有统计学意义(P<0.001)。结论对于BismuthⅡ型或双侧胆管均已受侵、无法手术的MHBO,如果胆道引流范围许可、患者的预计生存期>3个月,双金属支架行胆道引流更具优势。
Objective To compare the efficacy and safety of endometrial biopsy with double-sided or double-sided plastic stent in the treatment of malignant biliary obstruction (MHBO) in the hilar region. Methods A total of 142 patients with MHBO requiring bilateral biliary drainage were selected from May 2007 to December 2011. Thirty-two patients underwent biliary drainage with bimetallic stents (bimetallic stent group) and 110 patients underwent bilateral plastic stent biliary drainage Double plastic stent group), the success rate of endoscopic operation, the effective rate of postoperative yellow reduction, endoscopic retrograde cholangiopancreatography (ERCP) postoperative complications and stent patency. Results The success rate of the whole group was 100%. The effective rates of reduction of yellow after bimetal stent and double plastic stent were 96.9% (31/32) and 88.2% (97/110), respectively. There was no significant difference between the two groups (P> 0.05). Bimetallic stent group and double plastic stent group ERCP occurred in 2 cases and 6 cases of cholangitis, anti-inflammatory symptomatic, replacement or placement of nasal bile ducts after treatment, relieve symptoms; double plastic stent group 2 cases of stent partial spondylolisthesis. No pancreatitis, gastrointestinal bleeding, perforation and ERCP-related deaths occurred in either group. By the end of the study, 2 and 4 patients died of other causes, respectively, in the bimetallic scaffold group and the double-plastic scaffold group, and the biliary stent was clear at the time of death; in the bimetallic scaffold group and the double-plastic scaffold group, 8 and 29 Obstructive jaundice, to be re-placed or replaced plastic stent treatment. There was no significant difference in the incidence of postoperative complications between the two groups (P> 0.05). The median duration of patency was (248.53 ± 138.61) d in the bimetallic stent group and (101.76 ± 38.53) days in the double plastic stent group. The Log-rank test showed significant difference (P <0.001). Conclusions For patients with Bismuth type II or bilateral bile duct invasion and inoperable MHBO, biliary drainage is more advantageous if biliary drainage is allowed and the patient’s expected survival is> 3 months.