Rao K J, Varghese N M, Blake H, Theodossi A
Department of Gastroenterology, Mayday University Hospital, Thornton Heath, Surrey.
Gut. 1995 Aug;37(2):279-83. doi: 10.1136/gut.37.2.279.
During a 48 month period to December 1990, 367 patients, median age 75 years, with obstructive jaundice caused by common bile duct stones (201), malignant biliary obstruction (148), and benign biliary strictures (18), underwent therapeutic endoscopic retrograde cholangiopancreatography. Endoscopic biliary stenting and drainage was achieved in 343 of 367 patients attempted (93%), seven patients requiring a combined percutaneous endoscopic approach. Endoscopic stenting failed in 24 patients because of malignant duodenal infiltration (10), Billroth 2 gastrectomy (6), tight and extensive biliary strictures (6), peripapillary diverticulum (1), and technical failure (1). Prolonged follow up was available in 91% (311 of 343). The 30 day mortality was 5% (17 of 343), which included two procedure related deaths (0.6%) from fulminant pancreatitis and major sphincterotomy site bleeding. Early complications occurred in 14% (48 of 343) and late complications occurred in 11.9% (35 of 294) patients, as of the original 343, 17 had died within 30 days and another 32 were lost to follow up. Eighty patients with incomplete bile duct clearance and eight patients with benign biliary strictures had biliary stents inserted for 12-48 months (median 30). Endoscopic biliary stenting services are necessary in a district general hospital with technical success, death and morbidity rates comparable to other studies.
在至1990年12月的48个月期间，367例患者接受了治疗性内镜逆行胰胆管造影术，这些患者的中位年龄为75岁，病因包括胆总管结石（201例）、恶性胆管梗阻（148例）和良性胆管狭窄（18例）。在367例尝试进行治疗的患者中，343例（93%）成功实现了内镜下胆管支架置入及引流，7例患者需要联合经皮内镜方法。24例患者内镜支架置入失败，原因包括恶性十二指肠浸润（10例）、毕Ⅱ式胃切除术（6例）、紧密且广泛的胆管狭窄（6例）、乳头周围憩室（1例）和技术失败（1例）。91%（343例中的311例）患者获得了长期随访。30天死亡率为5%（343例中的17例），其中包括2例与手术相关的死亡（0.6%），分别死于暴发性胰腺炎和括约肌切开部位大出血。截至最初的343例患者，早期并发症发生率为14%（343例中的48例），晚期并发症发生率为11.9%（294例中的35例），17例在30天内死亡，另有32例失访。80例胆管清除不完全的患者和8例良性胆管狭窄患者置入胆管支架12 - 48个月（中位时间为3个月）。在地区综合医院，内镜胆管支架置入服务是必要的，其技术成功率、死亡率和发病率与其他研究相当。
