恶性梗阻性黄疸介入治疗187例临床分析

Clinical Analysis on Interventional Therapy for Malignant Obstructive Jaundice in 187 Cases

目的总结经皮穿刺肝胆道引流术(PTCD)及胆道内支架置入术(PTIBS)手术并发症的原因及处理方法。方法恶性梗阻性黄疸患者187例,男112例,女75例,PTCD治疗66例,PTCD+PTIBS治疗121例,穿刺右肝管引流143例,穿刺左肝管引流29例,双侧肝管同时穿刺引流15例。结果187例中,手术成功187例,PTCD成功率100%,发生并发症15例,其中菌血症或败血症8例,出血2例,胆汁血症3例,术后支架内血栓形成1例,支架放置失误1例。所有病例经对症治疗后无后遗症发生。结论PTCD创伤小,并发症少,成功率高,是晚期恶性梗阻性黄疸较好的引流方法。

Objective To analyze the complication and treatment of percutaneous transhepatic catheter drainage （PTCD） and percutaneous transhepatic insertion of biliary stents （PTIBS）. Methods Of 187 patients with malignant obstructive jaundice,male 112 cases, female 75 cases, 66 were treated with PTCD, 121 were treated with PTCD ＋ PTIBS. 143 cases through right hepatic duct drainage, 29 cases through left drainage, 15 cases through the double hepatic ducts. Results The operations were successful in all 187 patients. The successful rate was 100%. 15 cases had complication. Of the 15 patients, 8 suffered from bacteremia or blood poisoning, 2 had bleeding, 3 had bile with some blood, one had thrombus in the stent after operation, one received wrong insertion of stent. But none of them had sequela after correct treatment. Conclusion This method has minor wound and complication, the treatment technique is simple and the technical successful rate was high. It is one better drainage method in patients with malignant obstructive jaundice.