介入性胆道内引流术治疗恶性梗阻性黄疸

Percutaneous internal biliary drainage for treatment of malignant biliary obstruction

目的 回顾性分析介入性经皮胆道内引流治疗恶性梗阻性黄疸的疗效。方法 对 43例患者采用经皮肝穿刺胆道内引流治疗恶性梗阻性黄疸 ,内引流方式有内外引流管、金属内支架或塑料内涵管。结果 单纯内引流者 2 8例 ,2 5例置入金属支架 ,3例置入塑料内涵管 ;置入内外引流管者有 15例。术后 1周血清总胆红素 (TBIL)从术前的 5 0 1 6± 198 4μmol/L降至 2 30 7±138 5 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)。 3例于术后 1个月内死亡 ,均与胆道引流无直接因果关系。跟踪随访 36例 ,平均随访 5 9个月 ,7例仍存活 ,2 3例(6 3 9% )总胆红素降至正常范围。结论 经皮肝穿刺胆道内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 ,有限地延长患者生存时间。

Objective To evaluate the effect of percutaneous internal biliary drainage for treatment of malignant biliary obstruction.Methods Percutaneous internal biliary drainage was performed in 43 patients with malignant biliary obstruction via the inner outer draining catheter,the metallic stent or plastic endoprosthesis.Results The internal drainage was done with stent in 25 patients,with plastic endoprosthesis in 3 and with the inner outer draining catheter in 15.The total serum bilirubin decreased from 501 6±198 4μmol/L before the procedure to 230 7±138 5μmol/L one week after the procedure ( P <0 001),and both alkaline phosphatase and transaminase significantly decreased ( P <0 001).Three patients died of irrelevant situation to drainage within one month after procedure.Thirty six of 40 patients who survived for more than one month were followed up with an average of 5 9 months,including 7 patients alive.The total serum bilirubin decreased to the normal level within the period of follow up in 23 patients(63 9%)?Conclusion The percutaneous transhepatic internal biliary drainage is a safe and effective palliative therapy of malignant biliary obstruction.It can alleviate jaundice,improve the liver function and living quality,and limitedly extend the patients survival period.