胆管引流术与胆管支架置入术治疗恶性阻塞性黄疸的临床疗效比较

Comparison of the therapeutic effects of PTBD and PTBS in treatment of malignant obstructive jaundice

目的 比较经皮经肝胆管引流术（PTBD）和经皮经肝胆管支架置入术（PTBS）治疗恶性阻塞性黄疸的疗效.方法 210例阻塞性黄疸患者中,161例行PTBD,49例行PTBS.收集患者的临床资料,并通过电话随访或从患者复检记录中获取随访资料.结果 技术成功率为100%.术后3～5 d,PTBS组（15例）血清总胆红素（TB）下降了（178.04±42.32）μmol/L,血清直接胆红素（DB）下降了（83.97±23.63）μmol/L;PTBD组（28例）血清TB下降了（95.67±34.28）μmol/L,血清DB下降了（49.84±28.21）μmol/L,两组差异有统计学意义（P=0.017,P=0.035）.术后6～9 d,PTBS组（28例）血清TB下降了（188.22±79.90）μmol/L,PTBD组（126例）下降了（141.39±65.32）μmol/L,两组差异有统计学意义（P=0.014）;两组血清DB下降值差异无统计学意义（P=0.567）.PTBD组和PTBS组的中位通畅期分别为60和197 d,中位生存期分别为148和245 d,两组比较差异均有统计学意义（均P〈0.01）.结论 FIBS治疗恶性阻塞性黄疽的近期和远期疗效均优于PTBD.

Objective To summarize and compare the short-term and long-term clinical efficacy of percutaneous transhepatic biliary drainage （PTBD） and percutaneous transhepatic biliary stent （PTBS） in the treatment of malignant obstructive jaundice. Methods 210 cases of malignant obstructive jaundice underwent interventionsl therapy, of which 161 cases of drainage catheters placement and 49 cases of metalic stent implantation.Follow-up information was obtained through telephone review or check-up records. Results The technical success rate of technique was 100%. At 3-5 days after treatment, the serum total bilirubin in 15 metalic stent-treated patients was decreased by （178. 04 ± 42. 32） μmol/L, and direct bilirubin by （83. 97 ± 23. 63） μmol/L.Compared with those of 28 cases treted with drainage catheters： （95.67 ± 34. 28） μmol/L and （49. 84 ± 28. 21） μmol/L, there were statistically significant differences between the two groups （P =0.017 and P= 0.035）. At 6-9 days after treatment, the serum total bilirubin in 28 cases of metalic stent group was decreased by （188. 22 ± 79. 90） μmol/L,and that in 126 cases of drainage catheter group decreased by （141. 39 ± 65. 32） μmol/L The difference was statistically significant （P =0.014）. But the decline value of direct bilirubin had no significant difference. The median patency period and the median survival time of the drainage catheter group were 60 and 148 days, respectively,those of metalic stent group were 197 days and 245 days. There were statistically significant differences between the two groups （ P 〈0.05）. Conclusion The results of this study indicate that the short-term and long-term efficacies of metalic stent implantation are better than those of catheter drainage technique.