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1.docx

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]ObjectiveToexploreandsummarizetheclinicalstudyandnursingexperienceofpalliativetreatmentofadvancedmalignantbiliaryobstructionwithplasticstentplacedinthebileductunderfibroticduodenoscopyretrogradecholangiopancreatography.Methods58patientsdiagnosedwithmalignantbiliaryobstructionadmittedinourhospitalfromJanuarytoOctober2014wereselectedandunderwentpalliativetreatmentofbileductwithplasticstentplacedinthebileductinERCP.ThesuccessrateandthebiliaryresuscitationrateofplasticstentplacedinthebileductunderERCPforthepalliativetreatmentwerestudied.Thechangesoftotalbilirubin，directbilirubin，alkalinephosphatase，aspartatetransferaseandalanineaminotransferaseinpatientsweredetected.Thesurvivaltimeofpatientswasfollowedup.Theincidenceofpostoperativecomplicationsandintraoperativenursingandpostoperativecomplicationsnursingwereobserved.ResultsThesuccessfulrateofpalliativetreatmentwas93.1%inpatientswithmalignantbiliaryobstructionbyplacingplasticstentinfiberopticduodenoscopicretrogradecholangiopancreatography，andthepostoperativere-blockingratewas20.7%.Thepostoperativetotalbilirubin，directbilirubin，alkalinephosphatase，aspartatetransferaseandalanineaminotransferaseinpatientswasreducedsignificantly（P<0.05）.45caseswerefollowedup.Themeansurvivaltimewas（28.0±4.2）months（4-38months），theone-yearsurvivalratewas55.6%（25/45），andthetwo-yearsurvivalratewas26.7%（12/45）.Thepostoperativecomplicationsratewa