经皮肝穿刺胆管引流和经皮肝穿刺胆管支架置入治疗老年人恶性胆管梗阻

Application of percutaneous transhepatic cholangial drainage and percutaneous transhepatic cholangial stent implantion in treating malignant biliary obstruction in elderly patients

目的:探讨经皮肝穿刺胆管引流(percutaneous transhepatic cholangial drainage,PTCD)和经皮肝穿刺胆管支架(percu-taneous transhepatic cholangial sent,PTCS)置入对老年人恶性胆管梗阻的临床应用价值。方法:53例60岁以上老年人恶性胆管梗阻患者,35例施行PTCS置入,11例施行PTCD,7例施行单纯外引流,术后1周进行肝胆管造影复查,手术前及手术后1周检测血清总胆红素(total bilirubin,TBIL)及丙氨酸氨基转移酶(alanine aminotransferase,ALT)等指标。结果:32例患者支架一次性置入成功,3例患者行肝胆管外引流5～7d后成功置入支架。手术后1周TBIL及ALT较手术前明显下降(P<0.05)。胆管内支架置入患者的平均生存期为11.5个月,行胆管内外引流患者的平均生存期为5.5个月。结论:PTCD和PTCS置入治疗老年人恶性胆管梗阻操作简便、有效。

Objective：To evaluate the clinical value of percutaneous transhepatic cholangial drainage （PTCD） and percutaneous transhepatic cholangial stent（PTCS）implantation therapy for malignant biliary obstruction in the elderly patients.Methods：Fifty three patients over 60 years-old were treated with PTCS implantation （n=35）,PTCD for internal-external drainage（n=11）,or single external drainage（n=7）. The imaging examination was performed for all the patients one week after surgery. The serum levels of total bilirubin （TBIL） and alanine aminotransferase （ALT） were detected before and after surgery.Rusults：Metallic stents were successfully implanted in 32 patients during the surgery,and 3 patients were implanted 5 to 7 days later after PTCS. Both total serum levels of TBIL and ALT were significantly decreased at one week after surgery （P〈0.05）. The mean survival periods were 11.5 months for stent implantation patients and 5.5 months for PTCD patients. Conclusion：PTCD and PTCS are easy to perform and safe and effective in the treatment of malignant biliary obstruction of elderly patients.