经皮肝穿胆道引流术治疗梗阻性黄疸

OBSTRUCTIVE JAUNDICE WITH PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY AND DRAINAGE

目的评价经皮肝穿胆道引流术（PTCD）治疗梗阻性黄疸的临床价值。方法12例梗阻性黄疸，其中9例恶性梗阻（胆管癌4例、肝门淋巴结转移压迫胆管5例）采用PTCD姑息性引流；3例高危良性梗阻采用PTCD进行术前胆道减压。结果4例患者行内外引流术，8例行外引流术。经1～3周引流，8例血清总胆红素降至近正常，3例下降不满意，且例无效。3例高危良性梗阻者于引流减压后安全地进行了手术，7例恶性梗阻者于PTCD后1周～3个月死亡，另2例已无黄疸生存4个月。主要并发症为轻度胆道出血、菌血症和逆行感染各1例，经保守治疗痊愈。结论PTCD是姑息性治疗手术不能切除的恶性梗阻性黄疸的有效方法；对于高危良性胆道梗阻则更有意义。

To evaluate the clinical value of percutaneous transhepatic cholangiography and drainage (PTCD) for thetreatment of obstructive jaundice. Methods Twelve patients with binary obstruction were treated with PTCD,including binary carcinoma (n=4),lymph node metastasis (n~ 5),and high-risk benign binary obstruction (n=3). In 9 of the 12,binary drainagewas the primary palliative therapy, 3 of the 12 were drained for preoperative decompression. Results internal/exteral drainage wasachieved in 4 of the 12 and external catheter drainage in 8. The serum total bilirubin almost fell to normal within 1-3 weeks in 8,and no change occurred in 1. Three patients with high-risk benign binary obstruction underwent uneventful binary surgery aftersuccessful decompression. Seven patients died 1 week^3 months later,two patients are alive 4 months after catheter placement.Conclusion PTCD is a safe and effective means for palliation of malignant binary obstruction and is an important and lifesavingmethod for the treatment of highrisk benign binary obstruction.