Objective To study the efficacy of endoscopic naso-biliary drainage (ENBD) and endoscopic metal biliary endoprothesis (EMBE) for the patient with malignant biliary obstruction. Methods One hundred and twenty patients with malignant biliary obstruction confirmed by ERCP were divided into 2 groups: EMBE group in = 62) and ERBD group (n = 58), serum TBIL, ALT, ALP, GGT, TNF-α, the incidence of complications, and mortality of two groups were analyzed. Results There were no significant differences based on intubation success rate and complication rate between two groups (P < 0.05), with no deaths. One week after the treatment, the parameters of the liver function were significantly better than before treatment (P < 0.05). Eigty-nine patients were successfully followed-up, with the rate of 74.16% (89/120). Stent occlusion occurred in 12 cases in ERBD group, accounting for 30.77%(12/39), and 6 cases in the EMBE group, accounting for 12%(6/50). The median survival time was 5 months in ERBD group, and 9.3 months in EMBE group (P < 0.05). Conclusion From the situation of the follow-up, the incidence of stent occlusion and the median survival time in EMBE group were better than ERBD group, also ENBD and EMBE could effectively establish bile duct drainage, improve liver function in patients with malignant biliary obstruction.%目的 研究经内镜下塑料支架和金属支架对胆管恶性梗阻的治疗效果.方法 将我院2010年1月至2012年6月经ERCP确诊为胆管恶性梗阻的120例患者,分成金属支架引流术组(EMBE)(n=62)和塑料支架引流术组(ERBD)(n=58),监测两组患者血清总胆红素、谷丙转氨酶、碱性磷酸酶、谷氨酰胺转肽酶、血清TNF-α等的变化,并统计分析两组患者并发症的发生率以及死亡率.结果 两组插管成功率及并发症发生率为均无明显差异(P＞0.05),无死亡病例.治疗1周后复查两组患者的肝功能各项指标,结果较治疗前有统计学差异(P＜0.05).两组成功随访89例,随访率为74.16％(89/120),12例ERBD患者发生支架阻塞,占30.77％(12/39),该组中位生存期为5个月.6例EMBE患者发生支架阻塞,占12％(6/50),该组中位生存期为9.3个月,两组比较P均＜0.05.结论 从随访看,支架阻塞发生率和中位生存期EMBE组均优于ERBD组,但两组均能有效的建立胆管内引流,改善患者的肝功能,具有创伤小、痛苦少、恢复快、无体外留管、符合生理过程等优点.
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