经皮胆道引流术治疗恶性梗阻性黄疸

Percutaneous biliary drainage for treatment of malignant biliary obstruction

目的 回顾性分析恶性梗阻性黄疸的介入性经皮胆道引流治疗方法及其疗效。方法 对4 7例患者采用经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸。先行PTC后探查通过阻塞段 ,如不能越过阻塞段 ,则直接进行外引流 ;如能越过阻塞段 ,则置入内外引流管作内外引流或置入金属支架或塑料内涵管作内引流。结果 内引流组 18例 ,15例置入金属支架 ,共 18枚 ,3例置入塑料内涵管 ,共 4根 ;内外引流组 15例 ,置入 18根内外引流管 ;外引流组 14例 ,置入 17根外引流管。术后 1周总胆红素从术前的 (5 14 .1± 2 0 4 .3) μmol/L降至 (2 38.4± 14 2 .8) μmol/L(P <0 .0 0 1) ,碱性磷酸酶与丙氨酸转氨酶均下降明显 (P均 <0 .0 0 1)。 4例于术后 1个月内死亡。跟踪随访 37例 ,平均随访 5 .3个月 ,8例仍存活。随访期内 18例 (48.6 % )总胆红素降至正常范围。结论 经皮肝穿刺胆道引流术是对恶性梗阻性黄疸的一种安全、有效的姑息性治疗方法 ,可明显缓解黄疸、减轻痛苦、提高生存质量 ,并可改善肝脏功能 ,有限地延长生存时间。

Objective To introduce the technique of percutaneous biliary drainage for treatment of malignant biliary obstruction and to eveluate its therapeutic effect. Methods Percutaneous biliary drainage was performed in 47 patients with malignant biliary obstruction. The biliary obstruction occurred in the common bile duct of 10 patients, in the common hepatic duct for 13, at the conjuction of right and left hepatic ducts in 24. The inner outer draining catheter, the metallic stent or plastic endoprosthesis was placed to drain the bile internally if the obstruction could be passed with guide wire after percutaneous transhepatic cholangiography, or the outer drainage could only be carried out. Results The internal drainage was done with stent in 15 patients and with plastic endoprosthesis in 3, the inner outer drainage in 15, and the external drainage in 14. The serum total bilirubin decreased from 514.1±204.3μmol/L before the procedure to 238.4± 142.8 μmol/L one week after the procedure( P <0.001), and both alkaline phosphatase and transaminase significantly decreased( P <0.001). Four patients died of irrelevant situation to drainage within one month after the procedure. Thirty seven of 43 patients who survived for more than one month were followed up with an average of 5.3 months, including 8 patients alive. The serum total bilirubin decreased to the normal level within the period of follow up in 18 patients(48.6%), and to less than half of the value before the procedure in 15(40.5%). Conclusions The percutaneous transhepatic biliary drainage is a safe and effective palliative therapy of malignant biliary obstruction with improving liver function, life quality, and survival rate.