经皮经肝胆管引流途径胆道支架置入与姑息性胆肠内引流治疗恶性梗阻性黄疸的疗效比较

Comparative efficacy of palliative biliary enteric drainage and percutaneous biliary stenting in the treatment of malignant obstructive jaundice

目的：探讨不能手术切除的恶性梗阻性黄疸患者行经皮经肝胆管引流（ PTCD）途径放置胆道支架与姑息性胆肠内引流减轻黄疸方式的疗效差异。方法回顾性分析蚌埠医学院第一附属医院肝胆外科2005年12月—2011年12月不能手术切除且资料完整的210例恶性梗阻性黄疸患者的临床资料，其中 PTCD 途径胆道金属支架置入术137例（支架组），男83例、女54例，年龄（67．64±12．68）岁；姑息性胆肠 Roux-en-Y 内引流术73例（引流组），男50例、女23例，年龄（64．69±12．99）岁。比较两组患者的疗效差异。结果支架组和引流组均可有效解除患者胆道梗阻、改善肝功能；在身体状况、黄疸程度及肝功能损害更严重的情况下，支架组在解除胆道梗阻、改善肝功能方面优于引流组，且不增加手术并发症和住院时间；两组术后生存时间分别为（9．25±6．24）个月和（10．36±8．02）个月，差异亦无统计学意义（P〉0．05）。结论对于失去手术切除肿瘤机会的恶性梗阻性黄疸患者，可选择PTCD途径胆道金属支架置入术解除胆道梗阻、改善全身状况，其与姑息性胆肠内引流相比具有简便、安全、创伤小、可重复及可为后续治疗创造条件等优点，可作为首选。

Objective To compare the therapeutic effects of different palliative drainage way on the malignant obstructive jaundice patients who can not perform a surgical resection. Methods Clinical data of 210 malignant obstructive jaundice patients from December 2005 to December 2010 who could not perform a surgical resection were analyzed retrospectively, and the therapeutic effects of palliative internal drainage and percutaneous biliary stent were compared. Among them, biliary mental sents implantation by the way of percutaneoas transhepatic cholangial drainage（PTCD） in 137 cases, （83 males, 54 females）, the average age was （67. 64 ± 12. 68） years, the average survival time was （9. 25 ± 6. 24） months. Palliative biliary intestinal in drainage in 73 cases （50 males, 23 females）, the average age was （64. 69 ± 12. 99） years. Results Biliary obstruction was effectively relieved in both groups and the liver function was improved. In the physical condition, when jaundice and liver dysfunction were more severe, the stent group was better than the drainage group in relief of the biliary obstruction and liver function improvement, surgical complications and length of hospital stay did not increase. During the postoperative survival time, the stent group was （9. 25 ± 6. 24） months and the drainage group was （10. 36 ± 8. 02） months, the difference was not statistically significant （P 〉 0. 05）. Conclusions In the treatment of malignant obstructive jaundice patients who can not perform a surgical resection, biliary mental sents implantation is the first choice because of its being simple, security, less trauma and repeatability.