经皮国产胆道金属内支架置入术治疗恶性梗阻性黄疸

Percutaneous biliary drainage and domestic metallic stents implantation for the treatment of malignant biliary obstructive jaundice

目的：探讨国产胆道金属内支架的经皮经肝穿刺置入技术及其临床应用价值。方法：1996年7月～2006年10月经皮经肝穿刺胆道金属内支架置入术治疗恶性梗阻性黄疸患者167例。其中67例患者置入国产胆道金属内支架,男42例,女25例,年龄28～88岁。首先经皮经肝穿刺胆道造影,再选择性穿刺理想肝内胆管分支,送入导丝导管通过胆道梗阻段后导入硬交换导丝,沿该导丝送入球囊预扩张病变节段后置入胆道金属内支架,最后送入内-外引流管引流观察5天左右后撤出。结果：67例患者置入国产胆道金属内支架96枚,术中均未出现严重并发症,术后住院治疗5～10天。术后1个月复查血清总胆红素,均降至术前的1/2以下,44例降至正常范围。谷丙转氨酶、谷氨酸转肽酶均较术前显著下降。6个月生存48例,12个月生存14例,2例生存2年。结论：国产胆道金属内支架置入术治疗恶性梗阻性黄疸安全有效,价格低,治疗效果与进口胆道支架无明显差异。可明显缓解黄疸,减轻痛苦,提高生存质量,改善肝脏功能,延长生存时间。

Objective：To observe the clinical value of the technique of percutaneous biliary drainage and domestic metallic stents implantation for the treatment of malignant biliary obstruction.Methods：Percutaneous biliary drainage was performed in 167 patients with malignant biliary obstructive jaundice from 1996 to 2006,of these,67 cases underwent the operation of domestic metallic stents implantation,including 42 males,25 females, aged from 28 to 88 years.After percutaneous biliary moulding,guide wire and catheter were inserted into branches of biliary duct selectively and pushed through the obstruction position.Then,they were replaced by ultra-solid guide wire.Balloon and metallic stents were inserted through ultra-solid guide wire.A drainage tube was sent into billiary duct after the implantation of stents,and removed 5 days later.Results：96 domestic metallic stents were applied in 67 patients,no serious complication occurred.All these cases had their liver functions checked one month after operations.The total serum bilirubin decreased to less than 50 percent of that before operations as well as ALT and GGT decreased obviously in all the patients,serum bilirubin decreased to normal in 44 cases.48 cases survived for 6 months,14 patients survived for 12 months,2 survived for 24 months.Conclusion：Domestic metallic stents implantation is an useful,safe,economic and effective method for the treatment of malignant obstructive jaundice.It can yield immediate remission of jaundice and improvement of liver function,and also,can improve the life quality,prolong survival time of the patients.No significant difference was found between the effection of domestic stents and import stents.