介入治疗恶性阻塞性黄疸75例临床分析

Clinical analysis of interventional treatment of 75 patients with malignant obstructive jaundice

目的探讨恶性阻塞性黄疸的介入治疗方法和疗效。方法75例恶性阻塞性黄疸患者均有不同程度的全身皮肤、巩膜黄染，胆红素升高、肝功能下降。术前做上腹部cT平扫＋增强，或做磁共振胰胆管造影。采用Seldinger穿刺技术，行经皮肝穿胆管造影（PTC）及经皮肝穿胆道引流术（PTCD），引流7～10d造影复查，胆管回缩后行胆道支架置入术（EMBE），并针对原发病进行治疗。结果75例患者全部穿刺成功，置入78条引流管、15个胆道支架。术后3d胆红素明显下降，皮肤、虹膜黄染逐渐消退，4周后肝功能恢复正常。术后半年内死亡2例，1年生存率为68％。结论经皮肝穿胆道引流管置入术、胆道支架置入术能明显改善恶性阻塞性黄疸患者的临床症状、生活质量，延长带病生存时间。

Objective To investigate the method and efficacy of interventional treatment in ma- lignant obstructive jaundice. Methods A total of 75 patients with malignant obstructive jaundice had different levels of body skin, sclera jaundice, elevated bilirubin, declined liver function. Before the sur- gery, the plane of the CT scan for epigastric parts ＋ enhanced scan, or for MRCP. Using the Seldinger puncture technique, percutaneous transhepatic cholangiography （PTC） and percutaneous transhepatic biliary drainage （PTCD） was given. Drainage for 7 -10 days, and then the angiography was reviewed. When the bile duct retraction, the biliary stenting （EMBE） was planted, and the primary disease were treated. Results All the 75 patients had successful puncture, 78 drainage tubes were placed, 15 biliary stents were placed. Three days after surgery, bilirubin decreased significantly, yellowish discoloration of skin and iris faded gradually, liver function returned to normal after 4 weeks. Two patients died within 6 months after surgery, and the 1 -year survival rate was 68%. Conclusions Percutaneous transhepatic biliary drainage tube implantation, biliary stenting can significantly improve the clinical symptoms, quali- ty of life of the malignant obstructive jaundice patients, and prolong the survival time.