摘要目的 探讨内镜下胆管支架植入术(ERBD)及鼻胆管引流术(ENBD)对肝门部胆管癌(HACC)的临床疗效.方法 回顾性分析2010年1月至2016年1月成功行ERBD及ENBD的87例HACC患者的临床资料,对两种术式后患者胆管炎发生率、术后4周内胆管再梗阻发生率、总胆红素下降情况及生存期进行对比分析.结果 ERBD组与ENBD组术后重症胆管炎发生率[29.2％(14/48)比10.3％(4/39),x2 =4.689,P=0.030]及术后4周内胆管再梗阻发生率[47.9％(23/48)比23.1％(9/39),(2 =5.710,P=0.017]差异有统计学意义,两组患者术后2周及4周总胆红素下降情况均有良好的效果,与术前比较差异有统计学意义(P＜0.05),两组间总胆红素下降幅度比较差异无统计学意义(P＞0.05).两组患者中位生存时间[14(0～60)周比34(2～96)周,x2=10.101,P=0.010]差异有统计学意义.结论 ENBD在HACC患者姑息治疗上比ERBD具有一定优势.

abstractsObjective To evaluate the clinical effect of endoscopic retrograde biliary drainage (ERBD) and endoscopic naso-biliary drainage (ENBD) on hilar cholangiocarcinoma (HACC).Methods The clinical data of 87 patients with HACC,who underwent ERBD and ENBD form January 2010 to January 2016,were retrospectively analyzed.The incidence of postoperative severe cholangitis,biliary obstruction again within 4 weeks,reduction of total bilirubin and survival time were studied.Results There were significant differences between ERBD group and ENBD group on the incidence of severe cholangitis[29.2％ (14/48) VS 10.3％ (4/39),x2 =4.689,P=0.030] and bile duct obstruction in 4 weeks after operation [47.9％ (23/48) VS 23.1％ (9/39),x2=5.710,P =0.017].The total bilirubin within 2 weeks and 4 weeks postoperatively was significantly reduced compared with that before operation (P＜0.05).There was no statistical difference in descend range of total bilirubin between the two groups.There was significant difference between ERBD group and ENBD group in the median survival time [14 weeks (range,0-60 weeks) VS 34 weeks (range,2-96 weeks),x2 =10.101,P=0.010].Conclusion Compared to ERBD,ENBD has certain advantages on palliative care for HACC.