支架联合PCS在恶性梗阻性黄疸中的应用研究

Expandable metallic biliary endoprothesis (EMBE) and port catheter system (PCS) in malignant obstructive jaundice

目的：探讨恶性梗阻性黄疸的内支架植入术后，动脉药盒植入术局部治疗的价值。方法：３６例均已不能或不宜行外科手术治疗的恶性梗阻性黄疸病人，随机分为单纯内支架治疗（ Ｅ Ｍ Ｂ Ｅ）组和 Ｅ Ｍ Ｂ Ｅ 加 Ｐ Ｃ Ｓ治疗组。结果：３６例中３１例胆管引流内支架植入术成功，其中之１３例行 Ｅ Ｍ Ｂ Ｅ，１８例行 Ｅ Ｍ Ｂ Ｅ＋ Ｐ Ｃ Ｓ。随访１～１２个月， Ｅ Ｍ Ｂ Ｅ 组：１～３个月内６例（５０％ ）出现再闭塞。２～６个月内死亡８例，占６１５％ ，１２个月内死亡１１例，占８４６％ 。 Ｅ Ｍ Ｂ Ｅ＋ Ｐ Ｃ Ｓ组４例（２２２％ ）１～３个月后出现再闭塞，２～６个月内死亡６例，占３３３％ ，１２个月内死亡９例，占５００％ 。两组再闭塞率及死亡率相比，经 ｔ检验， Ｐ＜ ００１， Ｅ Ｍ Ｂ Ｅ＋ Ｐ Ｃ Ｓ组与 Ｅ Ｍ Ｂ Ｅ 组有显著差异性。结论：恶性梗阻性黄疸 Ｅ Ｍ Ｂ Ｅ 加 Ｐ Ｃ Ｓ治疗优于单纯 Ｅ Ｍ Ｂ Ｅ，是一种较好的局部治疗方法。

Objective:To investigate the local value of placement of expandable metallic biliary endoprothesis and port catheter system in treatment of malignant biliary obstruction.Methods:Thirty six cases with malignant biliary obstruction who could not be or were not suited for surgical treatment,were randomly divided into two groups:EMBE group, both EMBE and PCS group.Results:EMBE was successfully placed in 31 cases of biliary drainage in 36 cases,among which 13 cases underwent EMBE and 18 cases underwent PCS at the base of EMBE.Follow up time was 1~12 months .For EMBE group:6 cases (50%) developed reobstruction in 1~3 months;8 cases (61.5%) died in 2~6 months,and 11 cases (84.6%) died in 12 months;For EMBE and PCS group:4 (50%) cases reobstructed after 1~3 months,6 (33.3%) cases died in 2~6 months,and 9 cases (50%) died in 12 months.Conclusion:The two groups have significant difference in reobstruction rate and mortality rate by t test ( P <0 01).EMBE combined with PCS is a more effective and better local therapy method than EMBE in treatment of malignant biliary obstruction.