经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸(附51例报告)

Percutaneous placement of endoprotheses for treatment of malignant biliary obstruction: a report of 51 cases

目的：研究经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸的临床价值。材料与方法：５１例恶性梗阻性黄疸患者，在经皮胆道造影后进行了胆道内支架置入。其中置入塑料内支架者９例，自展式金属内支架者４２例，共使用胆道内支架５６枚。结果：全组治疗前、后血清总胆红素相差的均数±标准误为１６７±５２μｍｏｌ／Ｌ，Ｐ＜０．００５。５１例中，总胆红素恢复正常或接近正常者３６例，总胆红素下降百分比＞５０％者８例，下降百分比为２５％～５０％者４例，下降百分比＜２５％者３例。全组３０天病死率５．９％（３／５１），早期并发症１９．６％（１０／５１）。２６例有完整随访的患者（平均５．６个月），死亡１１例（４２．３％），内支架阻塞４例（１５．４％），其中３例进行了再次介入治疗。结论：经皮胆道内支架置入术是姑息性治疗手术不能切除的恶性梗阻性黄疸的有效方法。

Purpose: To study the clinical value of percutaneous implantation of biliary endoprotheses for treatment of malignant biliary obstruction. Materials and methods: A total of 56 endoprotheses were placed percutaneously in 51 patients for palliation of malignant biliary obstruction, of them, 9 plastic endoprotheses were placed in 9 patients, and 47 self expandable metallic endoprotheses in 42 patients. Results: The difference between post and ante operation in the serum total bilirubin level of 51 patients was 167±52 μmol/L, P <0.005. The 30 day mortality rate was 5.9%( n =3). The early complication rate was 19.6%( n =10). No procedure related death occurred. In 26 patients with follow up (mean follow up time 5.6 months), 11 patients died, and 4 patients developed recurrent jaundice and/or cholangitis. Conclusion: Percutaneous placement of biliary endoprotheses was effective and safe for palliation of malignant biliary obstruction.