经皮经肝胆道引流治疗恶性阻塞性黄疸近期疗效与并发症观察

Percutaneous transhepatic biliary drainage in treatment of malignant obstructive jaundice:clinical efficacy and complications

目的探讨经皮经肝胆道引流术治疗恶性阻塞性黄疸近期(1个月内)疗效,总结并发症发生率以及有效处理措施。方法回顾性分析88例在我科接受经皮经肝胆道引流术患者的病历资料。统计其在术后1个月内肝功能化验指标并与术前相比较;观察术后并发症及处理措施。结果83例患者血清总胆红素水平较术前降低30%以上,引流术的有效率为94.3%(83/88)。引流术后血清总胆红素、谷丙转氨酶、谷草转氨酶均较术前显著降低(P<0.05)。引流术后并发症包括胆道感染、引流管全部或部分滑脱、胆道出血、引流管胆泥堵塞不通,其发生率依次为37.5%(33/88)、20.45%(18/88)、17.04%(15/88)、4.55%(4/88);其他少见并发症包括肺部感染、败血症、胰腺炎、死亡,其发生率均为1.13%(1/88)。除死亡患者外,其余并发症均经相应措施得到有效处理。结论经皮经肝胆道引流可有效改善恶性阻塞性黄疸患者肝功能,减轻黄疸;术后并发症以胆道感染居首位,严重并发症及死亡率低。

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage（PTBD） within one month in the treatment of malignant obstructive jaundice,and to summarize the incidence of complications and effective treatment measures.Methods Hospital records were reviewed for 88 consecutive patients with malignant biliary obstruction who underwent PTBD procedures in our department.The indexes of hepatic function before PTBD and within one month after PTBD were compared.The incidence of complications and corresponding treatment measures were also documented.Results Serum total bilirubin decreased more than 30% in 83 patients and the efficacy rate of PTBD procedure was 94.3%（83/88）.Serum total bilirubin,alanine aminotransferase,aspartate aminotransferase significantly decreased（P0.05） within one month after PTBD.Common complications associated with PTBD included cholangitis in 33 pateints（37.5%）,drainage tubes displacement in 18 patients（20.45%）,hemobilia in 15 patients（17.04%）,tube occlusion in 4 patients（4.55%）.Other rare complications included pulmonary infection,septicemia,pancreatitis and death,their incidences were all 1.13%（1/88）.All complications except for death were successfully treated with effective measures.Conclusion Hepatic function can be improved by PTBD without serious complications in patients with obstructive jaundice.The cholangitis shows the highest incidence among all complications.