Objective To analyze clinical effects of laparotomic biliary stent placement and endoscopic biliary stent placement on liver function in patients with advanced malignant obstructive jaundice.Methods Totally 35 malignant obstructive jaundice patients with metal memory alloy biliary stent placement operations through laparotomy (laparotomy group,23 cases) and endoscopic retrograde cholangiopancreatography (ERCP) (ERCP group,23 cases) from May 2010 to May 2014 in Zhongshan Hospital Affiliated to Dalian University were retrospectively analyzed.Changes of liver function were analyzed between groups.Results All patients were operated successfully.One week after operation,serum levels of bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase (AKP) and glutamyhransferase (GT) were all significantly lower than those before surgery in both groups [laparotomy group:(211 ± 37) μmol/L vs (321 ± 54) μ mol/L,(81 ± 16) U/L vs (113±19)U/L,(46±10)U/Lvs (83±18)U/L,(354 ±81)U/Lvs (554±115)U/L,(241 ±47)U/L vs (486 ±96) U/L;ERCP group:(254 ±62)μmol/L vs (385 ± 37) μmol/L,(106 ± 17) U/L vs (146 ±23) U/L,(82±20)U/L vs (104 ±20)U/L,(520± 119)U/L vs (596 ± 134)U/L,(304 ±64)U/L vs (536 ± 133)U/L](P ＜0.01 or P ＜0.05).In laparotomy group,serum levels of bilirubin before operation and ALT,AST,AKP,GT 1 week after operation were all significantly lower than those in ERCP group(P ＜ 0.05).In all of 35 cases,serum levels of bilirubin,ALT,AST,AKP,GT 1 week and 2 weeks after operation and albumin 2 weeks after operation were all significantly lower than those before operation [(225 ± 46),(179 ± 38) μmol/L vs (343 ±49)μmol/L;(90±16),(73±15)U/L vs (124±22)U/L;(59±15),(54±12)U/L vs (90±18)U/L;(411 ±94),(297 ±85) U/L vs (568 ± 121) U/L;(262 ±53),(219 ±48) U/L vs (503 ± 116) U/L,(39 ±5) g/L vs (40 ± 8) g/L] (P ＜ 0.05);the serum level of bilirubin 2 weeks after operation was significantly lower than that 1 week after operation (P ＜ 0.05).In present study,major complications included 2 cases of mild cholangitis,2 cases of mild pancreatitis and 3 cases of biliary tract bleeding;there were 4 cases (17.4％) in laparotomy group and 3 cases(25.0％) in ERCP group;the incidence of complications had no significant difference between groups(P ＞ 0.05).Conclusion Both laparotomic biliary stent placement and endoscopic biliarv stent placement can effectively relieve biliary tract obstruction and improve liver function in the treatment of advanced malignant obstructive jaundice.%目的 比较开腹与内镜下胆道内支架置入治疗晚期恶性梗阻性黄疸的临床效果.方法 回顾性分析2010年5月至2014年5月于大连大学附属中山医院就诊的35例晚期恶性梗阻性黄疸患者,采用金属记忆合金胆道支架分别经开腹手术(开腹手术组,23例)和经内镜逆行性胰胆管造影术(ERCP)(ERCP组,12例)置入.比较2组患者手术前后肝功能变化情况.结果 所有患者均成功置入支架并达到引流目的.2组患者术后第1周血清胆红素、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(AKP)及谷氨酰转移酶(GT)均明显低于术前[开腹手术组:(211±37) μmol/L比(321±54) μmol/L,(81±16) U/L比(113±19) U/L,(46±10) U/L比(83±18) U/L,(354±81) U/L比(554±115) U/L,(241±47) U/L比(486±96) U/L;ERCP组:(254±62) μmol/L比(385±37) μmol/L,(106 ± 17) U/L比(146±23) U/L,(82±20) U/L比(104±20) U/L,(520±119) U/L比(596±134) U/L,(304±64) U/L比(536±133) U/L](P＜0.01或P＜0.05);开腹手术组术前血清胆红素及术后第1周血清ALT、AST、AKP及GT明显低于ERCP组(P＜0.05).35例患者术后第1周和第2周血清胆红素、ALT、AST、AKP、GT及术后第2周血清白蛋白均明显低于术前[(225±46)、(179±38) μmol/L比(343±49) μmol/L,(90±16)、(73±15) U/L比(124±22) U/L,(59±15)、(54±12) U/L比(90±18) U/L,(411±94)、(297±85) U/L比(568±121) U/L,(262±53)、(219±48) U/L比(503±116) U/L,(39 ±5)g/L比(40±8)g/L];术后第2周血清胆红素低于术后第1周(均P＜0.05).本研究中胆道内支架置入术后的主要并发症共有轻度胆管炎2例,轻度胰腺炎2例及胆道出血3例,其中开腹手术组发生术后并发症4例(17.4％),ERCP组发生术后并发症3例(25.0％);2组术后并发症发生率差异无统计学意义(P＞0.05).结论 开腹与ERCP置入胆道支架治疗恶性梗阻性黄疸均可有效解除梗阻,改善肝功能,提高患者生活质量.根据病情选择合适的支架置入方式,实施个体化治疗,可提高胆道支架置入的安全性和有效性.
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