经皮胆道金属支架置入姑息性治疗肝门部胆管癌

Percutaneous Biliary Metal Stent Implantation for Hilar Cholangiocarcinoma

目的探讨经皮经肝胆道引流（percutaneous transhepatic cholangial drainage,PTCD）途径胆道金属支架置入姑息性治疗失去手术切除机会的肝门部胆管癌（hilar cholangiocarcinoma,HCCA）的临床应用价值。方法 2008年4月～2012年3月,对21例失去切除机会的HCCA,先在超声引导下行PTCD,1周后在DSA透视下行胆道金属支架置入,将PTCD的外引流转为胆道支架内引流。结果 21例HCCA血清总胆红素（TBIL）从术前（290.29±155.98）μmol/L术后1周降至（103.01±53.83）μmol/L（t=7.00,P=0.00）;血清直接胆红素（DBIL）从术前（199.46±128.73）μmol/L术后1周降至（45.71±25.99）μmol/L（t=6.19,P=0.00）,丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（γ-GT）术后1周均明显下降（P〈0.01）,术后平均生存时间10.2月,95%置信区间7.74～12.69月。结论经PTCD途径胆道金属支架置入是姑息性治疗失去手术切除机会的HCCA的一种有效方法,具有简便、创伤小、安全、可重复等优点。

Objective To discuss the clinical application value of biliary metal stent implantation by percutaneous transhepatic cholangial drainage（ PTCD） to cure advanced hilar cholangiocarcinoma（ HCCA）. Methods Twenty-one cases of HCCA were treated from April 2008 to March 2012. All the cases were given PTCD under the guidance of ultrasonography,and then were placed a biliary metal stent under DSA after one week. The external drainage of PTCD was used as internal biliary drainage.Results The total bilirubin（ TBIL） was decreased from（ 290. 29 ± 155. 98） μmol / L preoperatively to（ 103. 01 ± 53. 83） μmol / L at 1 week after surgery（ t = 7. 00,P = 0. 00）. The direct bilirubin（ DBIL） was decreased from（ 199. 46 ± 128. 73） μmol / L preoperatively to（ 45. 71 ± 25. 99） μmol / L at 1 week after surgery（ t = 6. 19,P = 0. 00）. The levels of ALT,AST,and γ-GT were all decreased significantly after surgery（ P〈0. 01）. The average survival time was 10. 2 months after surgery（ 95% CI： 7. 74- 12. 69months）. Conclusion The biliary metal stent implantation is an effective method for palliative treatment of advanced HCCA with advantages of simple performance,minimal invasion,safety,and repeatable manipulation.