肝门胆管癌两种姑息性治疗方法并发症及适应证的比较

目的:比较经内镜逆行胆道支架置入术与经皮经肝穿刺胆道支架置入术对肝门胆管癌的近期治疗效果及适应证。方法:回顾性将肝门胆管癌患者60例按不同治疗方法分为经皮经肝穿刺胆道支架置入术组(35例)及经内镜逆行胆道支架置入术组(25例),比较经不同治疗方法后肝门胆管癌患者近期肝功能的恢复、相关并发症发生率及不同类型肝门胆管癌行不同治疗方法的成功率。结果:经内镜逆行胆道支架置入术同经皮经肝穿刺胆道支架置入术成功率分为80%和92%,在术后胆道出血及胰腺炎并发症方面,两种治疗方法存在明显差异(P0.05);Ⅳ型肝门胆管癌治疗成功率经皮经肝穿刺胆道支架置入术存在明显优势(P0.05);经内镜胆道支架置入术与经皮经肝穿刺胆道支架置入术在支架术后胰腺炎方面未见明显差异(P0.05)。两组治疗在减黄,肝功能恢复方面未见明显差异。结论:在并发症方面两种治疗方法各有优缺点,在Ⅳ型肝门胆管癌治疗中以经皮经肝穿刺胆道支架置入术为佳,Ⅰ型及Ⅱ型肝门胆管癌以内镜逆行胆道支架置入术治疗为佳,Ⅲ型肝门胆管癌根据具体情况而定。

Comparison of Complications and Indications of Two Palliative Treatment for Hilar Cholangio Carcinoma

Objective To compare the short-term efficacy and to evaluate the indications of two palliative treatment in patients with hilar cholangiocarcinoma. Methods Sixty patients with hilar cholangiocarcinoma were randomLy divided into percutaneous transhepatic stenting （PTS） group （35 cases） and endoscopic retrograde biliary stenting （ERBS） group （25 cases）. The recent recovery of liver function, the morbidity rate and the success rates in the two groups were evaluated. Results The success rate of PTS and ERBS was 82.9% and 92% respectively. There was significant difference between the two treatment methods in complications of the biliary tract bleeding and of biliary infection （P 0.05）; In the IV type hilar cholangiocarcinoma the treatment success rate of percutaneous transhepatic stenting was obviously advantageous. Conclusion For the type IV hilar cholangiocarcinoma percutaneous transhepatic biliary stenting should be favored, for I and II types of hilar cholangiocarcinoma endoscopic retrograde biliary Stenting is indicated, and for III type of hilar cholangiocarcinoma one of the two therapies should be chosen according to the specific circumstanced.