恶性梗阻性黄疸合并胆汁分泌亢进的介入治疗

Interventional therapy of malignant obstructive jaundice with hepercholeresis

目的探讨介入治疗恶性梗阻性黄疸合并胆汁分泌亢进的临床效果。方法回顾性分析23例恶性梗阻性黄疸一期经皮肝穿刺胆管外引流(BED)术后并发胆汁分泌亢进患者的临床资料。所有患者均行二期手术治疗,12例行经皮肝穿胆管内外引流术(BIED),7例行胆道支架置入(PTCS),4例行BED联合经鼻空肠营养管胆汁自体回输。二期术后2周用直接胆红素(DBIL)下降程度及临床相关症状(乏力、纳差、口渴等)改善情况评价治疗效果。显效:DBIL下降程度≥50%,临床症状完全改善。有效:DBIL下降程度≥50%,临床症状部分改善。无效:DBIL下降程度<50%,无论临床症状是否改善。结果18例显效,4例有效,1例无效。1例BIED患者于二期术后第2天出现胰腺炎,1例于二期术后第10天出现引流管堵塞。其余患者住院期间未出现相关并发症,住院时间(25.8±2.7)d。结论介入治疗恶性梗阻性黄疸合并胆汁分泌亢进,疗效确切,具有一定的临床应用价值。

Objective To investigate the clinical effect of interventional treatment of malignant obstructive jaundice combined with with hepercholeresis.Methods The clinical data of 23 patients with hepercholeresis after primary percutaneous transhepatic biliary drainage(BED)for malignant obstructive jaundice were retrospectively analyzed.All patients underwent second-stage surgical treatment,12 patients underwent percutaneous transhepatic biliary drainage(BIED),7 patients underwent biliary stent placement(PTCS),and 4 patients underwent BED combined with transnasojejunal feeding tube bile autotransfusion.Two weeks after the second stage operation,the treatment effect was evaluated by the degree of direct bilirubin(DBIL)decrease and the improvement of clinically relevant symptoms(fatigue,poor appetite,thirst,etc.):remarkable:the degree of DBIL decrease was more than 50%,the clinically related symptoms were completely improved;effective:the degree of DBIL decrease was more than 50%,the clinical symptoms were partially improved;ineffective:the degree of DBIL decrease was less than 50%,regardless of the improvement of clinical symptoms.Results The treatment was effective in 18 cases,effective in 4 cases and ineffective in 1 case.One patient with BIED developed blockage of drainage tube 10 days after the second stage operation;one patient with BIED developed pancreatitis on the second day after the second stage operation,and the remaining patients did not have related complications during hospitalization,with an average length of stay(25.8±2.7)days.Conclusion Interventional treatment of malignant obstructive jaundice combined with hepercholeresis has definite curative effect and has certain clinical application value.