PTCD+金属支架治疗恶性阻塞性黄疸600例分析

600 patients with malignant obstructive jaundice treated by percutaneous transhepatic cholangial drainage and metallic stent

目的观察经皮经肝胆管穿刺置管引流(PTCD)+金属支架置入术对恶性阻塞性黄疸的疗效。方法对600例恶性阻塞性黄疸患者进行回顾性分析,其中胆管癌261例,胰头癌109例,肝癌107例,胆囊癌25例,胃癌术后43例,肝转移癌43例,Vater壶腹癌12例,均采用PTCD+金属支架置入术治疗。结果技术成功率100%。2例术后2 h出现胆道出血,经积极治疗出血停止;5例术后出现胆道感染,经治疗后感染得到控制。无其他严重并发症。术后患者全身状况改善,血清总胆红素水平显著下降。中位生存期6.5个月。术后存活半年以上298例,其中129例于术后6、7、12个月再次出现阻塞性黄疸。结论 PTCD+金属支架置入术具有操作简单、疗效显著的优点,是治疗恶性阻塞性黄疸的理想方法。

Objective To observe the effect of percutaneous transhepatic cholangial drainage（PTCD） treatment of malignant obstructive jaundice with metallic stent.Methods All of 600 malignant obstructive jaundice patients,including cholangiocarcinoma in 261 cases,pancreatic head cancer in 109 cases,hepatoma in 107 cases,carcinoma of gallbladder in 25 cases and recurrent gastric carcinoma in 43 cases,metastatic tumors of the liver in 43 cases,carcinoma of Vater ampulla in 12 cases,were treated by PTCD with metallic stent.Results The technical successful rate was 100%.2 cases with biliary tract bleeding after release of the metallic stent with PTCD on 2 hours were controlled by effective clinical treatment.5 cases with biliary tract infection after release of the stent were also controlled by effective clinical treatment.Other cases had no severe complications.After operation,the living periods of patients were 2.5-24 months,average was 6.5 months.The 298 cases were alive more than half a year.Obstructive jaundice reappeared after release of stent in 6,7 and 12 months in 129 patients.Conclusions Treating obstructive jaundice with PTCD and metallic stent is relatively simple and effective.It is a better method for treating malignant obstructive jaundice.