高龄患者胆道梗阻的急诊治疗策略

The Emergency Treatment Strategies of Elderly Patients with Biliary Obstruction

目的:探讨经皮肝穿刺胆管引流术(PTCD)在治疗高龄患者胆道梗阻的临床应用。方法:选择本院自2007年5月-2012年5月收治的48例高龄胆道梗阻患者,采取超声引导联合X线透视下经皮肝穿刺胆管引流术(PTCD),穿刺左叶胆管10例,穿刺右叶胆管33例,同时穿刺左右叶胆管5例,对比治疗前后肝功能指标的变化,观察有效率。结果:48例患者均一次手术成功,均未出现出血、胆汁血管漏等并发症,术后显效36例,有效10例,无效2例,总有效率95.8%;治疗后肝功能各项指标(ALT、AST、STB、r-GT、ALP)明显改善,治疗前后肝功能比较差异均有统计学意义(P<0.05)。结论:超声引导联合X线透视下经皮肝穿刺胆管引流术(PTCD)是治疗高龄胆道梗阻患者的有效方法,创伤小、安全经济、并发症少,能明显改善患者生存质量、延长生存时间,值得临床推广应用。

Objective:To investigate the percutaneous transhepatic biliary drainage in the treatment of elderly patients with biliary obstruction. Method:48 elderly patients with biliary obstruction adopt which admitted to our hospital form May 2007 to May 2012 joint X-ray Ultrasound-guided percutaneous transhepatic biliary drainage,10 cases of puncture of the left hepatic duct,puncture the right lobe bile duct in 33 cases,and 5 cases of bile duct puncture left lobe,compared before and after treatment changes in liver function.Result:The operation of 48 patients were successful,and there was no bleeding,bile vascular leakage and other complications,36 cases were cured after operation,10 cases were effective,2 cases were ineffective, the total efficiency was 95.8%;the indexes of liver function after the treatment(ALT,AST,STB,r-GT,ALP)significantly improved,before and after the treatment of liver function difference there were statistically significant(P<0.05).Conclusion:PTCD has a significant effects on treating elderly patients with biliary obstruction,which was worthy of clinical widely.