恶性梗阻性黄疸的介入治疗

目的　探讨经皮肝胆管引流和置入内支架治疗恶性梗阻性黄疸的方法及并发症的预防。材料与方法　 130例恶性梗阻性黄疸患者接受经皮肝胆管引流 ,男 83例 ,女 47例。年龄 31～ 86岁 ,平均 6 3 .5岁。其中胆管癌 5 7例 ,转移癌 2 3例 ,肝癌 2 0例 ,胰腺癌 2 2例 ,胆囊癌 8例。结果　 97例放置了胆管支架 ,其中 2 8例因多支胆管梗阻除放置支架外还放置了引流管 ,33例单纯放置了内、外引流管。血胆红素 1周内由 2 3 .4± 16 .2mg/dl降为 15 .7± 8.8mg/dl ,肝内多发胆管梗阻胆红素下降不明显。与操作有关的并发症为感染 15例 ,3例出现败血症 ,肝功能损害 11例 ,胆管出血 2例。术后 30天内患者死亡率为 9.2 % (12 /130 )。结论　恶性梗阻性黄疸介入治疗方法简单、疗效确切 ,能延长患者的生存期。

Interventional Procedure in Malignant Biliary Obstruction

Objective　To study the techniques and complications of transhepatic percutaneous biliary drainage and stent implantation for the treatment of malignant biliary obstruction.　Materials and Methods　Percutaneous stent implantation and internal-external catheter drainage were adopted in 130 patients (83 males and 47 females) with malignant biliary obstruction. Biliary obstruction was caused by biliary duct carcinoma (n=57), hepatic carcinoma (n=20), metastases (n=23), pancreatic carcinoma (n=22) or carcinoma of gallbladder (n=8).　Results　Ninety-seven patients received biliary stent implantation, in 28 of them a drainage-catheter was placed. Thirty-three patients were simply treated with internal-external drainage. TLB in serum decreased from 23.4±16.2mg/dl to 15.7±8.8mg/dl within one week after the procedure. Complications included infection (n=15), which was related to interventional procedure and caused septicemia (n=3), hepatic dysfunction (n=11) and hemobilia (n=2). The mortality in 30 days was 9.2% (12/130).　Conclusion　Percutaneous transhepatic biliary drainage and stent implantation are simple, effective treatment for the malignant biliary obstruction.