介入技术在恶性梗阻性黄疸治疗中的应用

The Value of Interventional Imaging Technology in the Treatment of Hepatic Portal Vein Carcinoma with Obstructive Jaundice

目的 探讨超声引导及数字减影血管造影技术（DSA）下经皮经肝胆管金属支架植入术在恶性梗阻性黄疸治疗中的应用价值.方法 回顾性分析2011年1月-2013年1月我中心60例恶性梗阻性黄疸及肝功能严重损害患者,先行超声引导下经皮经肝胆管穿刺引流术（PTCD）,再在DSA下经PTCD窦道植入胆道金属支架,将外引流转变为生理性内引流,以改善肝功能.结果 60例患者术前血清总胆红素平均值为（386±95） μmol/L,术后第3天、第7天、第10天血清总胆红素平均值分别下降到（260±85） μmol /L、（220±81） μmol/L与（189±68）μmol /L（P＜0.05）,碱性磷酸酶（AKP）与y-谷氨酰转肽酶（γ-GT）均下降明显（P＜0.05）,出现并发症7例（11.7％）.结论 超声及DSA引导经皮经肝胆道内置引流术是一种治疗恶性梗阻性黄疸的有效方法,具有安全、简便、经济和可重复等优点.

Objective To explore the value of guided ultrasound and percutaneous transhepatic cholangio metal stent implantation under DSA in late liver bile duct carcinoma accompanied by malignant obstructive jaundice. Methods Retrospective analysis from January 2011 to January 2013 in Chengdu military region general hospital surgery center of the PLA of 60 cases of bile duct carcinoma with obstructive jaundice was performed, and liver function damaged. PTCD, ultrasound guided, then under DSA to put PTCD antrum into biliary metallic stents, to increase physiological internal drainage to improve the liver function. Results 60 cases of preoperative serum total bilirubin （386±95） gmol/L was decreased to postoperative 3 day（260±85）μmol/L,7 day（220±81）μmol/L and 10 day of （189± 68）μmol/L （P〈0. 05）, alkaline phosphatase and gamma GGTP also decreased significantly （P〈 0.05）. Complications occurred in 7 cases （11. 7%）. Conclusion Ultrasound and DSA mediated percutaneous transhepatic cholangio ,built-in drainage is a kind of treatment of advanced liver bile duct carcinoma with malignant obstructive jaundice. It is effective and has the advantages of safety, convenient, economic and repeatable.