恶性梗阻性黄疸介入治疗后近期并发症的分析和处理

The postoperative short-term complications of interventional therapy for malignant obstructive jaundice: its analysis and management

目的分析经皮经肝穿刺胆道引流术(PTCD)治疗恶性梗阻性黄疸近期并发症的原因及临床表现,总结诊疗经验,降低其发生率和病死率。方法回顾性分析中国医科大学附属第一医院2009年12月—2011年12月296例恶性梗阻性黄疸接受PTCD患者术后2周内并发症的发生率、临床表现及治疗结果。结果 58例患者(19.6%)术后出现并发症,包括胆道感染29例、肝动脉出血6例、急性胰腺炎15例、胆心反射6例、肾衰竭1例、再发胆道梗阻2例。其中2例胆道出血患者、3例胆道感染患者及1例肾衰竭患者经治无效死亡,余患者均病情好转。结论 PTCD术后并发症种类较多,一些严重的并发症可导致患者死亡。通过术前充分准备,术中及术后积极处理,可有效防止多数严重并发症的发生。

Objective To analyze the causes and clinical manifestations of the postoperative short- term complications occurred after percutaneous transhepatic cholangial drainage （PTCD） for patients with malignant obstructive jaundice, and to summarize the experience of their diagnosis and treatment in order to decrease the incidence and mortality. Methods A total of 296 patients with malignant obstructive jaundice who had received FTCD were enrolled in this study. The incidence, clinical manifestations and therapeutic efficacy of the complications occurred within two weeks after PTCD were retrospectively analyzed. Results A total of 58 cases （19.6%） developed complications after PTCD, including bihary infection （n = 29）, hepatic arterial hemorrhage （n = 6）, acute pancreatitis （n = 15）, gallbladder-cardiac reflex during operation （n = 6）, renal failure （n = 1） and biliary re-obstruction （n = 2）. Among these patients, 2 cases with biliary hemorrhage, 3 cases with biliary infection and 1 case with renal failure died after treatment. The remaining patients recovered from the illness. Conclusion PTCD can cause many kinds of complications, and some severe ones can cause death. Nevertheless, sufficient preoperative preparations, active management taken during and after the operation can effectively prevent many severe complications from happening.