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目的比较经PTC或ERC两种途径放置胆道支架治疗恶性胆管梗阻的疗效。方法 PTC途径:在超声引导下选择胆管走行与胆总管夹角较大、扩张的左右肝内胆管,穿刺置管引流,1周后再置入支架,共68例(其中有2例系ERC途径失败者)。ERC途径:在十二指肠镜下逆行插入引流管于胆总管内,经造影显示梗阻部位,其引导丝通过梗阻部位,然后沿引导丝置入支架,共53例。结果 经PTC或ERC途径放置支架成功率分别为100%(68/68)和96.2%(51/53),2组均未发生出血及漏胆并发症。全部患者获随访1～18个月(平均12.4个月),结果PTC组和ERC组放置支架后6个月内死亡者分别为7和5例,18个月仍存活者分别为17和9例。结论对失去手术机会或不能耐受手术的恶性胆管梗阻患者采取支架置入是有效解除梗阻、延长生存时间和提高生存质量的最佳方法。位于胆总管下端和壶腹部的梗阻首选ERC途径放置支架;位于肝门部及以上的梗阻应以PTC途径放置支架为宜。
Objective To compare the curative effect of placing biliary stents by PTC or ERC in the treatment of malignant biliary obstruction. Methods PTC pathways: under the guidance of ultrasound, the choledocholithiasis was selected and the included angle was larger than that of the common bile duct. The expanded left and right intrahepatic bile ducts were punctured and inserted into the scaffolds for a week. A total of 68 cases (of which 2 were ERC loser). ERC pathway: retrograde insertion of the drainage tube in the common bile duct under the duodenoscope, angiography showed obstruction site, the guide wire through the obstruction site, and then placed along the guide wire stent, a total of 53 cases. Results The success rates of stent placement via PTC or ERC were 100% (68/68) and 96.2% (51/53), respectively. No bleeding or complication occurred in both groups. All patients were followed up for 1 to 18 months (mean, 12.4 months). Results There were 7 and 5 deaths within 6 months after stent placement in PTC and ERC groups, respectively, and 17 and 9 survived at 18 months . Conclusion Stent implantation in patients with malignant biliary obstruction who lost their chance of surgery or can not tolerate surgery is the best way to relieve the obstruction, prolong the survival time and improve the quality of life. Obstruction located in the lower end of the common bile duct and the ampulla of the ERC approach preferred placement of the stent; located in the hilar and above the obstruction should be placed PTC stent placement is appropriate.