合理选择介入方式治疗高位胆道梗阻的探讨

Study of reasonable selecting interventional methods in treating high-positioned biliary tract obstruction

目的：探讨高位胆道梗阻介入治疗方法的选择及临床疗效。方法：2005年1月～2008年1月，我科治疗高位胆道梗阻患者45例。13例行胆道内外引流加支架置入术，17例行支架置入后肝动脉化疗和/（或）栓塞。6例行单纯经皮胆道内外引流．3例行射频治疗后置入胆道支架．3例肝动脉栓塞后置入支架。2例行单纯射频治疗，1例行肝动脉灌注化疗栓塞。结果：39例患暂术后1周黄疸减轻或消失（总胆红素〈100mol／L），总有效率87％；患者术后生存时间1～17月，平均7．2月；术后出现胆道感染5例．胆道出血3恻．胆汁性腹膜炎1例，均经保守治疗后好转。结论：根据具体情况选择合理的介入治疗方法能够有效治疗高位胆道梗阻．减轻黄疽．改善患者生活质量，延长生存时间。

Objective： To investigate the interventional methods and clinical efficacy in high-positioned bile duct obstruction. Methods： From Jan. 2005 to Jan. 2008,45 patients with high-positioned bile duct obstruction were treated in our department. Thirteen patients were treated with combined percutaneous transhepatic eholangial drainage （PTCD） and stent implantation,17 with transcatheter arterial chemo-embolization （TACE） and/or infusion （TAD followed lay stent implantation,6 with PTCD,3 with stent implantation followed by radiofrequency ablation,3 with stent implantion followed by TACE,2 with radiofrequcncy ablation anti 1 with TACE. Results： Thirty-nine patients obtained jaundice disappearance/palliation （total bilirubin 100μmol/L） with the total effective rate of 87%; the survival time was 1 month to 17 month,mean 7.2 month; postoperative complications included cholangitis in 5 patients,postoperative hemobilia in 3 and postoperative bile peritonitis in 1, which were all recovered with conservative treatment. Conclusion： Selection of reasonable interventional methods for high-positioned bile duct obstruction can effectively palliate jaundice,improve life quality and extend patients＇survival time.