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(1)
[摘要] 目的 探讨采用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治疗效果。 方法 回顾性分析2015年10月—2019年10月于该院就诊的胰腺癌合并梗阻性黄疸并行ERCP治疗的32例患者，观察其治疗前后血清总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(γ-GT)的变化情况。结果 32例患者经ERCP治疗成功29例(90.6%)，此29例患者中显效19例，有效8例，无效2例，成功率93.1%。术后1周TBIL(86.3±8.5)μmol/L，较术前(193.6±13.2)μmol/L显著降低(t=38.661，P<0.05)。术后1年，发生支架内梗阻3例，至2019年10月，29例ERCP成功者术后生存期52～1 461 d，中位生存期195 d。结论 ERCP对于胰腺癌导致的梗阻性黄疸成功率高，效果明显，复发率低，能够延长生存期，提高临床疗效。
[关键词] 内镜下逆行胰胆管造影术;胰腺癌;梗阻性黄疸
[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742(2020)07(a)-0041-03
[Abstract] Objective To explore the therapeutic effect of endoscopic retrograde cholangiopancreatography (ERCP) on obstructive jaundice caused by pancreatic cancer. Methods Retraspective analysis of 32 patients with pancreatic cancer complicated with obstructive jaundice and ERCP treatment in the hospital from October 2015 to October 2019. Observe the changes of serum total bilirubin (TBIL)， direct bilirubin (DBIL)， alkaline phosphatase (AKP) and γ-glutamyl transpeptidase (γ-GT) before and after treatment. Results 29 patients (90.6%) were successfully treated by ERCP in 32 patients. Of the 29 patients， 19 were markedly effective， 8 were effective， and 2 were not effective. The success rate was 93.1%. One week after operation， TBIL (86.3±8.5) μmol/L was significantly lower than that before operation (193.6±13.2)μmol/L (t=38.661， P<0.05). One year after operation， 3 cases of intra-stent obstruction occurred. By October 2019， 29 patients with successful ERCP had a postoperative survival period of 52 to 1 461 d and a median survival period of 195 d. Conclusion ERCP has a high success rate for obstructive jaundice caused by pancreatic cancer， an obvious effect， and a low recurrence rate. It can prolong the survival period， and the clinical efficacy is positive.
[Key words] Endoscopic retrograde cholangiopancreatography; Pancreatic cancer; Obstructive jaundice
胰腺癌(carcinorma of pancreas)指胰外分泌腺的惡性肿瘤，预后较差，一般症状出现后平均寿命约1年左右[1]。近年来，胰腺癌发病率不断上升，发病年龄多见于45～65岁，男女比例约为1.6∶1，是消化系统肿瘤中的第二大致死肿瘤，仅次于结直肠肿瘤，在发达国家的致死性肿瘤排名中也位居前列[2]。胰腺癌早期诊断率低，一经发现恶性程度高，且其转移期早，主要采取手术治疗。由于胰腺癌通常发现较晚，多数患者就诊时已丧失手术时机，手术率仅15%左右[3]。胰腺癌可发于胰腺任何部位，多发于胰头部，约占胰腺癌的60%，患者主要以腹痛、体重减轻、黄疸为主要临床症状，治疗以手术为主，对于失去手术时机，且并发梗阻性黄疸者，以胆道引流、减轻疼痛、提高生活质量为主要策略[4]。内镜下逆行胰胆管造影术(ERCP)创伤小、手术时间短，适用于病久年老体弱的胰腺癌晚期患者，是目前治疗胰腺癌导致梗阻性黄疸的一线手段，该院2015年10月—2019年10月使用ERCP对32例胰腺癌合并梗阻性黄疸患者进行治疗，疗效较好，现进行系统回顾并报道如下。
1 资料与方法
1.1 一般资料, http://www.100md.com(曹虎 刘萍平 刘金芳)
[关键词] 内镜下逆行胰胆管造影术;胰腺癌;梗阻性黄疸
[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742(2020)07(a)-0041-03
[Abstract] Objective To explore the therapeutic effect of endoscopic retrograde cholangiopancreatography (ERCP) on obstructive jaundice caused by pancreatic cancer. Methods Retraspective analysis of 32 patients with pancreatic cancer complicated with obstructive jaundice and ERCP treatment in the hospital from October 2015 to October 2019. Observe the changes of serum total bilirubin (TBIL)， direct bilirubin (DBIL)， alkaline phosphatase (AKP) and γ-glutamyl transpeptidase (γ-GT) before and after treatment. Results 29 patients (90.6%) were successfully treated by ERCP in 32 patients. Of the 29 patients， 19 were markedly effective， 8 were effective， and 2 were not effective. The success rate was 93.1%. One week after operation， TBIL (86.3±8.5) μmol/L was significantly lower than that before operation (193.6±13.2)μmol/L (t=38.661， P<0.05). One year after operation， 3 cases of intra-stent obstruction occurred. By October 2019， 29 patients with successful ERCP had a postoperative survival period of 52 to 1 461 d and a median survival period of 195 d. Conclusion ERCP has a high success rate for obstructive jaundice caused by pancreatic cancer， an obvious effect， and a low recurrence rate. It can prolong the survival period， and the clinical efficacy is positive.
[Key words] Endoscopic retrograde cholangiopancreatography; Pancreatic cancer; Obstructive jaundice
胰腺癌(carcinorma of pancreas)指胰外分泌腺的惡性肿瘤，预后较差，一般症状出现后平均寿命约1年左右[1]。近年来，胰腺癌发病率不断上升，发病年龄多见于45～65岁，男女比例约为1.6∶1，是消化系统肿瘤中的第二大致死肿瘤，仅次于结直肠肿瘤，在发达国家的致死性肿瘤排名中也位居前列[2]。胰腺癌早期诊断率低，一经发现恶性程度高，且其转移期早，主要采取手术治疗。由于胰腺癌通常发现较晚，多数患者就诊时已丧失手术时机，手术率仅15%左右[3]。胰腺癌可发于胰腺任何部位，多发于胰头部，约占胰腺癌的60%，患者主要以腹痛、体重减轻、黄疸为主要临床症状，治疗以手术为主，对于失去手术时机，且并发梗阻性黄疸者，以胆道引流、减轻疼痛、提高生活质量为主要策略[4]。内镜下逆行胰胆管造影术(ERCP)创伤小、手术时间短，适用于病久年老体弱的胰腺癌晚期患者，是目前治疗胰腺癌导致梗阻性黄疸的一线手段，该院2015年10月—2019年10月使用ERCP对32例胰腺癌合并梗阻性黄疸患者进行治疗，疗效较好，现进行系统回顾并报道如下。
1 资料与方法
1.1 一般资料, http://www.100md.com(曹虎 刘萍平 刘金芳)