纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻临床研究及护理体会
[摘要] 目的 探?总结纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻的临床研究及护理体会。 方法 选取58例2014年1～10月到我院就医的确诊为恶性胆道梗阻的患者，进行ERCP放置胆道内塑料支架姑息治疗。研究ERCP放置胆道内支架姑息治疗恶性胆道梗阻成功率、胆道再堵率，检测患者治疗前后总胆红素、直接胆红素、碱性磷酸酶、天冬氨酸转移酶、丙氨酸氨基转移酶变化情况。随访患者生存时间，观察术后患者并发症发生率以及术中护理和术后并发症护理。 结果 恶性胆道梗阻患者经ERCP放置胆道内塑料支架姑息治疗成功率高达93.1%，术后胆道再堵率为20.7%；术后患者总胆红素、直接胆红素、碱性磷酸酶、天冬氨酸转移酶、丙氨酸氨基转移酶等指标均显著下降（P<0.05）。随访45例，平均生存时间（28.0±4.2）个月（4～38 个月），1年生存率为 55.6%（25/45），2年生存率为 26.7%（12/45）；术后并发症发生率为8.6%，并发症经术后积极护理均得到缓解或消失。 结论 通过纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻是可行的，并发症较低；经有效护理治疗均可使并发症得到缓解或消失。
[中图分类号] R473.6 [文献标识码] B [文章编号] 1673-9701（2017）15-0132-04
[Abstract] Objective To explore and summarize the clinical study and nursing experience of palliative treatment of advanced malignant biliary obstruction with plastic stent placed in the bile duct under fibrotic duodenoscopy retrograde cholangiopancreatography. Methods 58 patients diagnosed with malignant biliary obstruction admitted in our hospital from January to October 2014 were selected and underwent palliative treatment of bile duct with plastic stent placed in the bile duct in ERCP. The success rate and the biliary resuscitation rate of plastic stent placed in the bile duct under ERCP for the palliative treatment were studied. The changes of total bilirubin， direct bilirubin， alkaline phosphatase， aspartate transferase and alanine aminotransferase in patients were detected. The survival time of patients was followed up. The incidence of postoperative complications and intraoperative nursing and postoperative complications nursing were observed. Results The successful rate of palliative treatment was 93.1% in patients with malignant biliary obstruction by placing plastic stent in fiberoptic duodenoscopic retrograde cholangiopancreatography， and the postoperative re-blocking rate was 20.7%. The postoperative total bilirubin， direct bilirubin， alkaline phosphatase， aspartate transferase and alanine aminotransferase in patients was reduced significantly（P<0.05）. 45 cases were followed up. The mean survival time was（28.0±4.2） months（4-38 months）， the one-year survival rate was 55.6%（25/45）， and the two-year survival rate was 26.7%（12/45）. The postoperative complications rate was 8.6%. The complications were relieved or disappeared after active nursing. Conclusion It is feasible to place plastic stent in fiberoptic duodenoscopic retrograde cholangiopancreatography for palliative treatment of advanced malignant biliary obstruction， and the complication is low. The complications can be alleviated or disappear through effective nursing treatment. 综上所述，通过纤维十二指肠镜逆行胆胰管造影放置胆道内塑料支架姑息治疗晚期恶性胆道梗阻是可行的，并发症较低；即使出现并发症，经有效护理治疗均可使并发症得到缓解或消失。
