经皮肝穿治疗恶性梗阻性黄疸的临床研究

Interventional Therapy of Malignant Obstructive Jaundice

目的探讨经皮肝穿治疗恶性梗阻性黄疸的疗效及影响因素。方法 38例恶性梗阻性黄疸患者,胆管癌术后复发11例,胃癌术后转移8例,胰头癌9例,乳腺癌术后转移2例,肝癌8例,采用经皮肝穿刺胆管造影引流(PTCD)术(21例),裸金属内支架置入术(17例),2周后区域动脉灌注化疗或栓塞治疗37例,9例胰头癌患者结合聚焦超声放疗。结果 38例患者经皮肝穿技术成功率100%,PTCD或内支架置入2周后,血清总胆红素明显下降(395.6±278.0)limol/Lvs(52.4±60.56)wmol/L,P<0.01),肝功能明显改善。1例胃癌术后患者两天内死于内出血,其他37例患者均获得随访,平均生存9个月,最长21个月。0.5a内,17枚支架中4例出现阻塞,25条(4例患者放置2根)引流管中因脱出或不通畅更换5条。结论介入治疗恶性梗阻性黄疸是一种有效延长患者生存时间、减轻痛苦的姑息手段,引流通畅是保证疗效的关键。

Objective To study the clinical efficacy and relevant factor of interventional therapy of malignant obstructive jaundice.Methods Thirty-eight patient with malignant obstructive jaundice were treated by procedure of percutaneous transhepatic cholangiography and drainage（PTCD 21 cases）or uncovered metal stent insertion（17cases）,and also treated by regional target artery infusing chemotherapy or embolization 2 weeks after procedure.The underlying disease was biliary cancer in 11 patients,gastric metastasis in 8 patients,pancreatic cancer in 9 patients;liver cancer in 8 patients and breast metastasis in 8 patients,pancreatic cancer in 9 patients,liver cancer in 8 patients and breast metastasis cancer in 2 patients.Results The procedures were technically succeeded in all patients.The total serum bilirubin value decreased and the liver function improved in all patients.One case died of bleeding 2 days after the procedure.The mean survival time was 9 months and the longest was 21 months.In the follow up of half year period,4 out of 17 stent developed occlusion and were performed interventional procedure again,5 out of 25 drainage catheter were replaced for bad draining or dropping out.Conclusion Interventional therapy was effective to treat patients with malignant obstructive jaundice,improving life quality and prolonging survival time.