介入治疗联合TACE治疗恶性梗阻性黄疸的临床研究

Interventional therapy combined with TACE in the treatment of 36 cases of malignant obstructive jaundice

目的临床观察晚期肿瘤患者采用经皮肝穿胆道引流术（PTCD）或/及胆道支架置入术（PTBS）联合区域性肝动脉化疗栓塞术（TACE）治疗梗阻性黄疸的疗效及价值。方法对2012年2月至2013年12月期间病理确诊的36例恶性梗阻性黄疸患者行PTCD或/及PTBS,术后7～14 d患者黄疸减轻后行TACE,临床观察其肝功能变化、近期疗效以及远期并发症、患者生存时间。结果 PTCD术后,36例患者均引流成功,其中26例置入内外引流管＋胆道支架,Ⅰ/Ⅱ期共置入网状支架31枚,术后2周内均接受TACE治疗,根据术后复查情况决定下次TACE治疗时间,36例患者共接受TACE 117例次。术后随访3个月、半年、1年的生存率分别为91.6%、75%、47.2%,中位生存期10.1月,除2例引流管脱落外,未见其他严重并发症发生。结论 PTCD或/及PTBS联合TACE对晚期肿瘤患者恶性梗阻性黄疸一种较好的姑息性治疗办法,可明显改善患者症状,提高晚期生活质量。

Objective To evaluate the curative effect of percutaneous transhepatic cholangial drainage（ PTCD） and percutaneous transhepatic biliary stenting（ PTBS） combined with transcatheter arterial chemoembolization（ TACE） for the treatment of malignant obstructive jaundice.Methods PTCD and PTBS were carried out in 36 patients with malignant obstructive jaundice,7 ～ 14 days after the jaundice fade TACE was carried out. Efficacy,complications and survival rates were observed. Results After PTCD,The drainage were successful in all 36 patients; of them,26 patients had internal and external drainage tube plus biliary stent,and 31 medals mesh stents were implanted. All patients received the first TACE within 2 postoperative weeks,the followed TACE treatment was performed according to the patients＇ condition. And 117 TACE were conducted in 36 patients. The survival rates of 3- 6- and 12- months were 91. 6%,75%,47. 2% respectively,with the median survival time10. 1 months. No severe complication was found except falling off of draining tubes in two patients. Conclusion PTCD and PTBS combined with TACE is a good palliative therapy for malignant obstructive jaundice. The treatment can significantly improve symptoms and the quality of life of the patients.