肝门部胆管癌的非切除性辅助治疗方式选择

Choice of palliative measures for unresectable hilar cholangiocarcinoma

目的探讨肝门部胆管癌的非切除性辅助治疗方式。方法经皮肝胆管引流术(PTCD)22例(A组),其中12例放置金属内支架。胆肠吻合术29例(B组)。两组对胆管炎、引流管相关问题、黄疸、住院时间、是否用抗生素、止痛药六个参数进行评价,对1个月内生存质量进行评估。结果A组4例PTCD黄疸消退不明显或黄疸复发,B组仅3例黄疸消退不满意。A、B两组生存质量评估显示与引流管相关问题尤为明显(40.8%),其中PTCD5例,出现引流管滑移或阻塞,12例金属内支架一次性置入成功。结论金属内支架置入术是辅助治疗非切除性肝门部胆管癌的有效方法,其生存质量高于PTCD。

Objective To investigate the palliative measures for unresectable hilar cholangiocarcinoma.Methods 51 cases of unresectable hilar cholabgiocarcinoma were managed by nonoperative(22 cases,group A),including percutanons transhepatic biliary draiage(PTCD) 10 cases,metallic stent implantation 12 cases,and operative options with cholangio-enteric bypass(29 cases,group B).The quality of life was evaluated according to the results of six objective parameters in a month,including cholangitis,catheterrelated problems,jaundice,hospitalization,antiboyic and analgesic.Results In 41 cases,jaundice reduced satisfactorily after the treatment.However,The results was unsatisfactory in 4 cases(group A,40%) with PTCD procedure,and in 3 cases(group B) with cholangioenteric bypass.The result of the overall assessment of the quality of surrivval was significantly relative to catheter-related problems(40.8%),including 10 cases in group A(50%) with the complication of the slipped or blocked catheters.Stent implantation was successful in 12 cases.Conclusion The metallic stent provides good and effective drainage for unresectable hilar cholangiocarcinoma.The patients with metallic stent had a higher quality of survival than with PTCD.