恶性梗阻性黄疸胆道内涵管置入术28例

The Clinical Application of Percutaneous Transhepatic Plastic Stent Implantation for 28 Cases of Obstructive Jaundice

［目的］探讨经皮肝胆道内涵管置入治疗梗阻性黄疸的疗效及并发症。［方法］对４８例梗阻性黄疸患者分为两组，２８ 例为内涵管组，行经皮肝穿胆道内涵管置入术；２０例为对照组，用一般内科治疗（利胆、护肝等对症处理）。其中内涵管组２８例随 访 ３５至 ３５６天，观察近中期疗效和并发症。［结果］内涵管组：经皮肝胆道内涵管置入术技术成功率为 １００％。置入后血清总胆红 素水平较置入前明显下降（Ｐ＜０．０５）。对照组：随时间的延长血清总胆红素水平较治疗前明显上升（Ｐ＜０．００１）。开通时间平均为 ９８天，半年开通率为５３．５７％。内涵管组：并发症发生率２４．９５％，主要为胰腺炎和逆行胆道感染等，对照组：井发症发生率３０％（Ｐ ＜０．０５）［结论］经皮肝胆道内涵管置入术疗效可靠、安全，可作为胆管阻塞介入治疗的另一种选择。

[Purpose] TO investigate the effeet and complication of percutaneous transhepatic plastic stent implantation for obstructic jaun- dice. [Methods] Forty-eight cases of obstructive jaundice were randomly divided into two groups. Percutaneous transhepatic plastic stent implantation was performed in 28 patients with obstructive jaundice (Group A). Only internal medicine was offered in 20 patients with obstructive jaundice as control group (Group B). The effects and complications were observed with follow-up period of 35 ~ 356 days. [Results] Technical success rate was 100%. Serum total bilirubin decreased significantly after percutaneous transhepatic plastic stent implantation (P < 0 .05). While in the patients of Group B, serum total bilirubin ascended significantly after treatment with interal medicine (P < 0.001). In Group A,the mean patency time was 98 days, foe ratio of half-year patency was 53. 57% .The complications mainly including pancreatitis and retrograde biliary in- fection occurred in 24. 95% of patients. In the patients of Group B, the complications occurred in 30% of patients (P < 0 .05). [Conclusion] Percutaneous transhepatic plastic stent implantation is effective and safe, it can be used as a choice of interventional treatment to binary ob- struction.