恶性梗阻性黄疸的介入治疗与近期疗效分析

Analysis on the short-term efficacy of interventional therapy for malignant obstructive jaundice

目的评价介入治疗对恶性梗阻性黄疸的近期疗效。方法90例恶性梗阻性黄疸患者,其中,胆管癌31例,转移瘤28例,原发性肝癌16例,胰头癌11例,以及壶腹部癌4例均经介入治疗。接受经皮经肝穿刺胆汁引流术(PTBIED)者43例,接受胆道支架置入术(PTIBS)者47例。所有患者术前总血清胆红素(TSB)水平与术后3～7d及10～15d者进行了比较。结果90例患者的TSB水平从术前298.4(204.3～482.6)micromol/L降至术后3～7d的281.4(76.2～482.6)micromol/L(P<0.05)。76例患者的TSB水平从术前的298.4(204.3～482.6)micromol/L降至术后10～15d的146.2(37.6～358.6)micromole/L(P<0.01)。PTBIED与PTIBS二者间的效果未见明显差异。结论介入治疗术对于缓解恶性梗阻性黄疸的症状和提高患者的生存质量具有重要价值。而且是一种简便、安全和有效的方法。

Objective To assess the short-term efficacy of interventional therapy for malignant obstructive jaundice. Methods Ninety patients with malignant obstructive jaundice which comprised cholangiocarcinomas（n=31）, metastases（n=28）, primary hepatic carcinomas（n=16）, pancreatic head carcinomas（n=11）, and ampullar carcinomas（n=4） underwent interventional therapy. Percutaneous transhepatic biliary internal and/or external drainage （PTBIED） was performed in 43 patients and percutaneous transhepatic insertion of biliary stent （PTIBS） in 47. The level of preoperative total serum bilirubin （TSB）in all patients was compared with that at 3 to 7 days and 10 to 15 days after operation. Results The TSB level of 90 patients was reduced from 298.4 （204.3-618.8） micromol/L before operation to 281.4 （76.2- 482.6） micromol/L 3 to 7 days after operation（P〈0.05） . The TSB level of 76 patients was reduced from 298.4（204.3-618.8）micromol/L before operation to 146.2（37.6-358.6）micromole/L 10 to 15 days after operation（P〈0.01）. No significant difference was found in the effect between PTBIED and PTIBS. Conclusion Interventional therapy is a simple, safe and effective means to relieve the symptoms of malignant obstructive jaundice and to improve the life quality of the patients.