经皮肝穿胆汁引流治疗肝门胆管癌  

Percutaneous transhepatic biliary drainage for hilar cholangiocarcinoma

作　　者：钱晓军[1] 金文辉[1] 戴定可[1] 于平[1] 高堃[1] 翟仁友[1] 

机构地区：[1]首都医科大学附属朝阳医院放射科,北京100020

出　　处：《介入放射学杂志》2007年第10期669-672,共4页Journal of Interventional Radiology

基　　金：国家十一五课题资助项目(2007BAI05B06)

摘　　要：目的分析经皮经肝穿刺胆汁引流治疗无法手术的肝门部胆管癌的疗效。方法回顾性分析103例接受经皮经肝穿刺胆汁引流术治疗的肝门部胆管癌所致的梗阻性黄疸患者,经皮经肝穿刺胆管造影后,进行外引流和(或)内外引流、胆道内支架置入术等治疗。临床观察治疗后的近期疗效和生存时间。结果全部患者经皮经肝穿刺胆汁引流手术成功,成功率100%,根据Bismuth分型,其中Ⅰ型30例,Ⅱ型30例,Ⅲ型26例,Ⅳ型17例。留置支架39例,共47枚,引流管64例。治疗后总胆红素明显下降,由(386±162)μmol/L降至(161±117)μmol/L,差异有统计学意义(P<0.01)。术后2周总胆红素较术前明显好转76例,改善15例,无效12例,有效率为88.3%。术前合并感染17例,术后控制13例;术后并发胆道感染15例,胸部感染2例,13例出现一过性血清淀粉酶升高,8例血性引流液,1例胆道出血,1例幽门梗阻,30d内死亡9例。全组生存中位时间186d,1、3、6和12个月生存率分别为89.9%、75.3%、59.6%和16.9%。Ⅰ型、Ⅱ型明显较Ⅲ型、Ⅳ型预后好。结论经皮经肝穿刺胆汁引流术治疗肝门部胆管癌,可明显缓解黄疸,提高患者的生存质量,延长生存时间,为肿瘤进一步治疗提供机会。Objective To evaluate the effect of PTBD in treating malignant biliary obstruction caused by hilar cholangiocarcinoma. Methods We retrospectively analyzed the data of 103 patients （M：62, F：41 ）with malignant obstructive jaundice caused by hilar cholangiocarcinoma. After taking percutaneous transhepatic cholangiography, metallic stent or plastic external catheter or exterual-interual catheter for drainage was deployed and then followed up was undertaken with clinical and radiographic evaluation and laboratory examination. Results All patients went though PTBD successfully （100%）. According to Bismuth classification, all 103 cases consisted of Ⅰ type（N = 30）, Ⅱ type （N = 30）, Ⅲtype （N = 26） and Ⅳ type （N = 17）. Thirty-nine cases were placed with 47 stents and 64 cases with drainage tubes. 4 cases installed two stents for bilateral drainage, 2 cases installed two stents because of long segmental strictures with stent in stent, 1 case was placed with three stents, and 3 cases installed stent and plastic catheter together. Sixty-four cases received plastic catheters in this series, 35 cases installed two or more catheters for bilateral drainage, 28 cases installed external and internal drainage catheters, 12 cases installed external drainage catheters, and 24 cases installed both of them. There were 17 patients involving incorporative infection before procedure, 13 cases cured after procedure, and 15 new patients got inflammation after procedure. 13 cases showed increase of amylase（from May, 2004）, 8 cases had bloody bile drainage and 1 case with pyloric obstruction. Total serum bilirubin reduced from（386 ±162） μmol/L to（161 ± 117） μmol/L, （P 〈 0.01）short term curative effect was related with the type of hilar cholangiocarcinoma. The survival time was 186 days（median）, and 1, 3, 6, 12 month survival rate were 89.9%, 75.3%, 59.6%, 16.9%, respectively. Conclusion Percutaneous transhepatic bile drainage is a safe and effective palliative therapy of malignant o

关 键 词：肝门胆管癌 恶性梗阻性黄疸 经皮经肝穿刺胆汁引流 金属支架 

分 类 号：R735.8[医药卫生—肿瘤]