改良经皮经肝胆汁引流术在治疗116例恶性梗阻性黄疸中的应用

Improved percutaneous transhepatic biliary drainage for treatment of malignant obstructive jaundice:a report of 116 cases

目的：探讨改良经皮经肝胆汁引流术（percutaneous transhepatic biliary drainage,PTBD）在恶性梗阻性黄疸的临床应用价值。方法：回顾分析116例恶性梗阻性黄疸患者在B超引导下行改良PTBD术（121例次）的临床资料,其中胰头癌37例,壶腹部癌23例,肝门胆管癌30例,转移性癌26例。结果：113例118例次穿刺成功,成功率达97.4%。其中肝总管置管42例,右肝管置管44例,左肝管置管22例,左右肝管双置管5例。术后1周患者症状、体征均明显改善,表现为黄疸减轻,皮肤瘙痒缓解,情绪好转,食欲增加,血清总胆红素由术前的101.2-592.8μmol/L降至术后1周的24.9-278.3μmol/L,无严重并发症发生。结论：改良PTBD在治疗恶性梗阻性黄疸中的应用是安全、有效的,并可为进一步治疗创造条件。

Objective：To explore the clinical application of improved percutaneous transhepatic biliary drainage（FFBD） in treatment of malignant obstructive jaundice. Methods： The clinical data of 116 cases of malignant obstructive jaundice were analyzed retrospectively. Improved PTBD was carried out for all the patients including 37 cases of pancreatic head carcinoma,23 cases of ampulla carcinoma,30 cases of hilar cholangiocarcinoma and 26 cases of metastatic carcinoma. Results：The improved PTBD was successful in 113 patients （97.4%）. Among them, the PTBD tube was placed in the common hepatic duct in 42 cases, in the right hepatic duct in 44 cases,in the left hepatic duct in 22 cases and in both the left and the right hepatic duct in 5 cases. The signs of jaundice, skin itch, mode and appetite were greatly improved one week after the operation. The serum bilirubin decreased from 101.2 - 592.8 μmol/L to 24.9 - 278.3 μ mol/L one week after the treatment. No severe complications were observed. Conclusions： The improved PTBD proves to be safe and effective for treatment of malignant obstructive jaundice, and it makes the further treatment possible.