摘要目的 探讨奥曲肽联合ERCP+留置内支架治疗胰头癌并阻塞性黄疸患者的临床价值.方法 收集2006年1月至2011年12月武汉市中心医院消化内科收治的99例并发阻塞性黄疸的胰头癌患者,采用随机、平行对照的方法分为治疗组及对照组.对照组51例患者仅采用ERCP及留置内支架减黄治疗,治疗组48例患者在内镜治疗的同时给予奥曲肽0.1 mg皮下注射,每日2次,连续治疗90d以上,直至病死.观察治疗前后患者血胆红素水平的变化;恶心、呕吐、腹痛、腹泻、纳差等症状的改善情况;治疗发生的并发症及患者的生存时间.结果 对照组患者治疗后6例再次出现黄疸,考虑支架阻塞,其中3例再次行内支架植入后黄疸消退,3例未再次行支架置入.其余45例及所有治疗组患者的血胆红素均下降至基本正常(低于正常值的2倍).治疗前两组患者恶心、呕吐、腹痛、腹泻、纳差的发生率差异均无统计学意义,治疗后两组患者上述症状的发生率均较治疗前明显下降,且治疗组的下降显著优于对照组,差异均有统计学意义(P值均＜0.05).对照组有3例术后发生急性胰腺炎,治疗后缓解.治疗组无1例术后发生胰腺炎,但有3例注射部位发生皮肤疼痛,经更换注射部位后疼痛缓解.对照组患者平均生存时间为(7.3±5.3)个月,治疗组为(14.4±8.7)个月,差异有统计学意义(P＜0.05).结论 奥曲肽联合ERCP+留置内支架治疗胰头癌并阻塞性黄疸患者能明显改善患者生存质量,延长患者的生存时间.

abstractsObjective To investigate the effect of Octreotide on pancreatic head carcinoma patients with obstructive jaundice who underwent endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent placement.Methods Niney-nine patients hospitalized in Department of Gastroenterology of Wuhan Central Hospital from Jan 2006 to Dec 2011 were included in this study.All the patients were diagnosed as pancreatic head carcinoma with obstructive jaundice.The patients were randomly divided into the Octreotide treatment group and the control group.Both groups underwent ERCP with pancreatic duct stent placement for malignant biliary obstruction.The patients in Octreotide treatment group were injected with subcutaneous Octreotide at a dose of 0.1 mg twice per day for more than 90 day till death.The changes of serum total bilirubin before and after treatment were compared.The improvement of symptoms of nausea,vomiting,abdominal pain,diarrhea and anorexia was compared.The complication rates and survival were also determined.Results Postoperative recurrence of jaundice was observed in six patients in control group,and the cause may be stent occlusion,and 3 of the 6 patients underwent a second ERCP and stent placement,then jaundice was relieved,the other 3 patients did not receive a second ERCP.The serum bilirubin level in the remaining 45 patients returned to basically normal value (below 2 times of the normal value).The prevalence of nausea,vomiting,abdominal pain,diarrhea and anorexia in the 2 groups was not statistically different before treatment,and after treatment the prevalence of symptoms in the 2 groups was significantly decreased except for diarrhea.The decrease in Octreotide treatment group was more obvious than that in control group,and the difference between the two groups was statistically significant (P ＜ 0.01).In the control group,post-ERCP pancreatitis occurred in three patients,and all were cured after treatment.There was no post-ERCP pancreatitis occurred in the Octreotide treatment group.Minor pain at the injection site was noted in three patients in the Octreotide treatment group.Pain was relieved after changing the injection site.The survival was significantly longer in the Octreotide group than that in control group [(14.4 ± 8.7) months vs (7.3 ± 5.3) months,P ＜ 0.05),and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Octreotide can improve the quality of life and increase the survival of patients with pancreatic head carcinoma who undergo ERCP with pancreatic duct stent placement.