经内镜逆行胰胆管造影支架置入对老年恶性梗阻性黄疸患者的临床疗效和对肝功能及免疫功能的影响

发布时间：2018-07-29 12:33

【摘要】：目的探讨经内镜逆行胰胆管造影(ERCP)支架置入在老年恶性梗阻性黄疸患者治疗中的临床应用价值。方法选取2014年1月-2015年12月该院所收治的97例老年恶性梗阻性黄疸患者作为临床研究对象,根据治疗方式的不同随机分为研究组50例和对照组47例。研究组采用ERCP胆管支架置入术的临床治疗,对照组采用经皮肝穿刺胆道引流(PTCD)胆管支架置入术的临床治疗,并分别对两组患者的手术治疗情况、临床症状改善情况、肝功能变化情况、免疫功能变化情况以及并发症发生情况进行分析。结果与对照组相比,研究组手术成功率96.00%(48/50)略高于对照组96.31%(44/47),但差异无统计学意义(P0.05);研究组总有效率94.00%(47/50)明显高于对照组80.85%(38/47),差异有统计学意义(P0.05);研究组治疗2周后总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)和谷氨酰转移酶(GGT)均显著改善[TBIL(110.24±60.05)μmol/L,DBIL(82.43±46.19)μmol/L,ALT(86.79±39.30)IU/L,AST(53.65±35.81)IU/L,ALP(216.83±127.74)IU/L,GGT(196.52±100.64)IU/L],差异均有统计学意义(P0.05);研究组治疗后CD3+、CD4+和CD4+/CD8+的水平与对照组相比均明显提高[CD3+(70.24±5.62)%,CD4+(37.74±3.85)%,CD4+/CD8+(1.35±0.12)],而CD8+的水平则明显降低[CD8+(27.96±3.14)%],差异均有统计学意义(P0.05);研究组并发症总发生率8.00%(4/50),与对照组相比明显降低,差异有统计学意义(P0.05)。结论经ERCP支架置入对于老年恶性梗阻性黄疸患者手术治疗效果提高明显,以及对肝功能和免疫功能的改善均具有十分重要的临床意义。
[Abstract]:Objective to investigate the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) stent implantation in the treatment of elderly patients with malignant obstructive jaundice. Methods 97 cases of elderly patients with malignant obstructive jaundice treated in December January 2014 -2015 were selected as the clinical research subjects, and the different treatment methods were divided into 50 cases in the study group. 47 cases of the control group were treated with ERCP bile duct stenting, and the control group was treated with percutaneous biliary drainage (PTCD) stent implantation, and the surgical treatment of the two groups, the improvement of clinical symptoms, the change of liver function, the changes of immune function and the complication of the control group. Results compared with the control group, the success rate of the study group was 96% (48/50) slightly higher than the control group 96.31% (44/47), but the difference was not statistically significant (P0.05); the total effective rate of the study group was 94% (47/50) significantly higher than that of the control group (38/47), the difference was statistically significant (P0.05); the study group was treated with total bilirubin (TBIL) and direct bile after 2 weeks of treatment. DBIL, ALT, AST, alkaline phosphatase (ALP) and glutamyl transferase (GGT) significantly improved [TBIL (110.24 + 60.05) mu mol/L, DBIL (82.43 + 46.19) mu mol/L, ALT (86.79 + 39.30) IU/L, AST (216.83 + 127.74), 196.52 + 100.64), and the difference was statistically significant. The levels of CD3+, CD4+ and CD4+/CD8+ in the study group were significantly increased by [CD3+ (70.24 + 5.62)%, CD4+ (37.74 + 3.85)% and CD4+/CD8+ (1.35 + 0.12)), while CD8+ level decreased significantly (27.96 + 3.14)%], and the difference was statistically significant (P0.05), and the total incidence of complications in the study group was 8% (4/50), which was significantly lower than the control group. The difference is statistically significant (P0.05). Conclusion ERCP stent implantation is significant in the treatment of elderly patients with malignant obstructive jaundice, and it is of great clinical significance for the improvement of liver function and immune function.
【作者单位】：河北省衡水市哈励逊国际和平医院内科;
【分类号】：R735

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