经皮肝穿刺胆管引流术联合内窥镜逆行胰胆管造影术在恶性梗阻性黄疸治疗中的应用

Percutaneous transhepatic cholangial drainage combined with endoscopic retrograde cholangiopancreatography for malignant obstructive jaundice

目的探讨经皮肝穿刺胆管引流术(PTCD)联合内窥镜逆行胰胆管造影术(ERCP)在恶性梗阻性黄疸(MOJ)临床治疗中的应用价值。方法回顾性分析50例首次经ERCP途径放置胆道内支架失败的MOJ患者,采用PTCD联合ERCP治疗。结果患者均完成梗阻段胆道内支架置入以达到内引流;胆道内支架置入术后第1周血清总胆红素平均下降约150μmol/L,谷草转氨酶、谷丙转氨酶、碱性磷酸酶及谷氨酰转氨酶较术前明显下降(P<0.01)。并发症有胆管炎8例,胆道出血3例。结论PTCD联合ERCP置入胆道内支架可有效治疗MOJ患者的胆管梗阻,改善患者肝功能,临床应根据患者的病灶及全身情况选择联合治疗,提高治疗的安全性和有效性,减少并发症的发生。

Objective To discuss the value of percutaneous transhepatic cholangial drainage （PTCD）combined with endoscopic retrograde cholangiopancreatography（ERCP）to treat malignant obstructive jaundice（MOJ）.Methods The clinical data of 50 cases with MOJ,failed by first ERCP therapy placed biliary stent,were analyzed retrospectively.All were treated with PTCD combined with ERCP.Results The stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage.Compared with the level of the bilitubin before treatment,it decreased about 150μmol/L one week after the biliary stent insertion in all patients.Compared with the levels of glutamic oxalacetic transaminase,glutamic pyruvic transaminase,alkaline phosphatase and glutamyltranspeptidase before treatment,they all decreased one week after the stent insertion（P0.01）.Complications included 8 cases of chilangitis and 3 cases of bile duct hemorrhage.Conclusion PTCD combined with ERCP to treat MOJ is effective in relieving the bile duct construction with malignant biliary obstruction. This method can be chosen according to the systemic and local condition for every patient so as to improve the safety and efficiency,and to decrease the occurrence of complications.