经皮肝穿刺胆管引流治疗高位梗阻性黄疸

Upper obstructive jaundice treated with percutaneous transhepatic biliary drainge

目的探讨高位梗阻性黄疸的介入治疗方法及其疗效的评价。方法15例累及左、右肝管和胆总管上段的高位胆管梗阻患者(男11例,女4例,年龄41～78岁,平均63.5岁)施行经皮肝穿刺胆管引流(percutaneous transhepatic biliary drainge,PTBD),包括外引流和金属支架置入术。结果15例共行22次介入治疗,7例接受了两次P T B D,15例中12例放置了金属支架,15例患者初次P T B D术后,13例患者血清总胆红素明显下降,临床有效率为86.7%,13例患者血清总胆红素平均值由术前的248.16±116.07μmol/L下降到1周后的114.54±62.20μmol/L,PTBD前后的血清总胆红素的变化有显著统计学差异(p<0.001)。结论对于高位胆管梗阻的患者,采用P T B D是安全有效的姑息性疗法。

Objective To explore the interventional treatment for upper obstructive jaundice and evaluate its therapeutic effect. Methods： 15 patients （male 11 cases, female 4cases, age from 41 to 78 years old, mean 63.5 years old） with upper obstructive jaundice were treated with pereutaneous transhepatic biliary drainge （PTBD） including external drainge and percutaneous transhepatic biliary stent placement. Results： 22 procedures were performed in 15 cases, the second PTBD were performed in 7 patients. The stent placement were performed in 12 of 15 patients. After the initial procedure, the clinical success was obtained in 13 of 15 patients （13/15, 86.7%）.The average serum total bilirubin level was reduced obviously from 248. 16 ± 116.07μ mol/L before PTBD to 114.54 ± 62.20 μ mol/L one week later. There was significant difference between before operation and one weeks after procedure （P〈0.01）. Conclusion： PTBD was the safe and effective therapy for upper obstructive jaundice.