金属内支架治疗恶性梗阻性黄疸的临床研究(附33例分析)

Malignant biliary obstruction treated with metallic stents

目的：总结胆管金属内支架放置术的临床经验和疗效分析。材料与方法：恶性梗阻性黄疸患者３３例，男２３例，女１０例。胆管癌１６例，胰头癌２例，原发性肝癌２例，肝转移瘤３例，肝门淋巴结转移瘤压迫胆管１０例。本组共采用金属内支架行内引流３３例，共使用６种３８枚金属内支架。１２例支架放置术后加局部放射治疗和化学治疗（简称放、化疗）。结果：３３例采用经皮经肝穿刺置入胆管支架均获得成功，其中２９例一次性植入支架，４例先行胆汁引流术（ＰＴＢＤ）后再放置金属内支架；９例因胆管梗阻复杂，金属支架置入后仍保留引流导管，其中３例在置管１５～２００天后拔除引流管。２８例（８４．８５％）黄疸消退满意。本组中位生存期７个月，支架植入后加局部放、化疗组中位生存期１０个月。结论：胆管内金属支架治疗恶性梗阻性黄疸，可用于不能手术治疗的高位胆管梗阻，支架植入后加局部放、化疗可望提高远期疗效。

Purpose: The outcome of 33 patients with malignant biliary obstruction treated with metallic stents is presented. Materials and methods: Thirty eight biliary metallic stents were placed in 33 patients with malignant biliary obstruction. They were 52—71 years old (mean=61.7); 23 were male and 10 were female. The biliary obstruction was caused by biliary carcinoma ( n =16), pancreatic carcinoma ( n =2), hepatoma( n =2), metasasis in liver ( n =3) and lymph node metastasis ( n =10). Six types and 38 metallic stents were used. After stenting, 3 cases were treated with intrastent brachytherapy, 7 cases treated with external radiotherapy and 2 patients treated with interventional radiology. Patients were followed for 6—28 months, mean11 months. Results: Stent placement was successful in all 33 cases. The same time, 4 patients were treated with plastic tube for external drainage only. The successful rate was 90%. Twenty nine patients were placed in one time, 4 cases began with plastic tube which was replaced with metallic stents after 1—2 weeks. Nine had metallic stents and plastic tube, because of complicated obstruction. The external drainage catheters were removed after 15—200 days. Three patients had stents crossing the ampulla. In 28 cases (84.85%), jaundice was resduced satisfactorily while in 5 cases with complicated biliary obstruction, the result was unsatisfactory. The median survival was 7 months. After stenting, 12 cases were treated with local chemotherapy, brachytherapy or radiotherapy. The median suvival period was 10 months. Conclusion: The metallic stent provides good palliative drainage and is well tolerated by patients. It improves the survival rate when combimed with radiotherapy, brachytherapy and chemotherapy in patients with malignant biliary obstrution.