剪鼻胆管为内支架治疗高龄梗阻性黄疸疗效分析

肖广远　　吴一鸣　　陈炳荣　　周君　　肖卫星　　沈彬　　周海军

[摘要] 目的 探討治疗高龄梗阻性黄疸患者时剪鼻胆管为内支架在治疗中的应用价值。 方法 选择2019年6月至2020年5月我院收治的因梗阻性黄疸行内镜下逆行性胰胆管造影120例患者，通过随机数字表法分为观察组与对照组，每组各60例，对照组给予常规的手术治疗和处理方案，观察组给予鼻胆管引流后剪鼻胆管为内支架的治疗方案。比较两组在术前和术后的AKP、GPT、GOT、TBIL、DBIL、LPS、IL-6水平，观察不良事件发生率。 结果观察组在术后7 d、14 d的血清AKP、GPT、GOT、TBIL、DBIL水平均低于对照组，差异有统计学意义（P<0.05）;观察组术后14 d两组的LPS、IL-6水平均低于对照组，差异有统计学意义（P<0.05）;观察组不良事件发生率为10.00%（6/60），对照组为13.33%（8/60），两组比较，差异无统计学意义（P>0.05）。 结论 剪鼻胆管为内支架治疗高龄梗阻性黄疸，操作简单有效，有较高临床应用价值。

[关键词] 鼻胆管引流;内支架;梗阻性黄疸;胰胆管造影

[中图分类号] R735.8          [文献标识码] B          [文章编号] 1673-9701（2021）11-0077-04

Analysis on the therapeutic efficacy of nasal bile duct clipping as internal stent in the treatment of elderly obstructive jaundice

XIAO Guangyuan1   WU Yiming2   CHEN Bingrong1   ZHOU Jun1   XIAO Weixing1   SHEN Bin1   ZHOU Haijun1

1.Department of Hepatology， Jiaxing Hospital of Traditional Chinese Medicine in Zhejiang Province， Jiaxing   314000，China; 2.Institute of Hepatology，Affiliated Hospital of Jiaxing University， the First Hospital of Jiaxing， Jiaxing   314000， China

[Abstract] Objective To investigate the application value of nasal bile duct clipping as internal stent in the treatment of elderly obstructive jaundice. Methods A total of 120 patients with obstructive jaundice undergoing endoscopic retrograde cholangiopancreatography admitted to our hospital from June 2019 to May 2020 were selected as research objects， and the observation group（n=60） and the control group（n=60） were obtained by the random number table method. The control group was given conventional surgical therapy and treatment scheme， while the observation group was given the treatment scheme of nasal bile duct clipping as internal stent after nasal biliary drainage. The levels of AKP， GPT， GOT， TBIL， DBIL， LPS and IL-6 were compared between the two groups before and after operation， and the incidence of adverse events was observed. Results The levels of serum AKP， GPT， GOT， TBIL and DBIL in the observation group were all lower than those in the control group after 7 days and 14 days of operation， with statistically significant differences（P<0.05）. The levels of LPS and IL-6 in the observation group were all significantly lower than those in the control group after 14 days of operation， with statistically significant differences after comparison（P<0.05）. The incidence of adverse events in the observation group was 10.00%（6/60）， while the incidence of adverse events in the control group was 13.33% （8/60）， with no statistically significant difference after comparison （P>0.05）. Conclusion It is simple， effective and of high clinical value for nasal bile duct clipping as internal stent in the treatment of elderly obstructive jaundice.

[Key words] Nasal biliary drainage; Internal stent; Obstructive jaundice; Cholangiopancreatography

內镜下逆行性胰胆管造影（Endoscopic retrograde cholangio pancreatography，ERCP）是肝胆外科学在临床诊治过程中发展起来的一项重要的诊断与治疗技术，已有40多年的发展历程，该技术不断更新完善[1-2]，目前已被世界各地肝胆外科医生广泛应用于临床诊治，具有诊断确切、疗效迅速、创伤较小等优点[3-4]。但诊疗性ERCP仍属于有创性诊疗技术，治疗后有一定的临床并发症，多见术中感染、胰腺炎等[5-6]。自ERCP开展以来，笔者遇到较多的高龄梗阻性黄疸患者，由于一般身体状况差，无法耐受全麻手术，或拒绝手术。本研究采用ERCP联合鼻胆管引流（Endoscopic nosal biliary drainage，ENBD）退黄，待引流通畅，黄疸消退，再将鼻胆管在十二指肠乳头部剪断，剩余的鼻胆管做为胆管内支架，取得较好的临床疗效，2019年6月至2020年5月共为60例患者实施该套治疗方案，现报道如下。……