经皮肝穿刺胆道引流术及胆管内支架植入术在恶性梗阻性黄疸治疗中的应用

Application of percutaneous transhepatic biliary drainage and percutaneous transhepatic insertion of biliary stent in treating malignant biliary obstruction

目的评价经皮肝穿刺胆道引流(PTBD)及胆管内支架植入术(PTIBS)治疗恶性梗阻性黄疸的疗效。方法对56例恶性梗阻性黄疸患者采取PTBD或PTIBS,所有患者均经B超、CT或MRI明确诊断,并确定梗阻部位,其中高位梗阻19例,低位梗阻37例。梗阻原因包括肝癌14例,胆管癌11例,胆囊癌5例,胃癌伴淋巴结转移14例,壶腹部占位1例,胰头癌11例。术中根据造影结果选择合适方案。结果所有56例均成功完成手术。其中行PTBD11例,PTIBS40例,PTBD并PTIBS5例。TBIL由术前(295.65±152.86)μmol/L降至术后(151.05±107.36)μmol/L(P<0.01)。术后感染对黄疸消退有影响(P<0.01)。梗阻部位与黄疸消退情况比较差异无统计学意义(P=0.063)。结论经皮肝穿刺胆道引流及支架植入术治疗恶性梗阻性黄疸安全有效,可明显减轻黄疸,改善患者生活质量,延长生存期。

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage （PTBD）and percutaneous transhepatic insertion of biliary stent（PTIBS）for malignant biliary obstruction. Methods PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction,which were caused by hepatic carcinoma（n=14）,biliary duct carcinoma（n=11）,gallbladder carcinoma（n=5）, stomach carcinoma accompanied with metastasis of lymph node（n=14）,carcinoma of ampulla（n=1）or carcinoma of pancreatic head（n=11）.The diagnosis was confirmed by ultrasonography,CT or MRI in all patients.The obstructed site was well identified,including high obstruction in 19 patients and lower obstruction in 37 patients.Based on the imaging findings,suitable interventional procedure was employed. Results PTBD or PTIBS were performed successfully in all 56 patients,of them PTBD was adopted in 11, PTIBS in 40 and both PTBD and PTIBS in 5.The serum total bilirubin decreased from（295.65±152.86） μmol/L before the procedure to（151.05±107.36）μmol/L after the procedure（P〈0.01）.Postoperative infection could affect the fading of jaundice（P〈0.01）,but the location of the obstruction carried no relationship with the fading of jaundice（P=0.063）.Conclusion Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction,which can markedly relieve patient of jaundice, improve the quality of life and elongate the survival period.