内镜下胃空肠造瘘联合胆道外引流治疗恶性胆道梗阻  

Percutaneous endoscopic gastrostomy/jejunostomy combined with percutaneous transhepatic cholangio-drainage in treating complete malignant obstruction of biliary tract

作　　者：舒建昌 杨绮红 张文茹 黎铭恩 张晓燕 庞春梅 宋慧东 聂丽芬 罗国彪 吕霞 

机构地区：[1]暨南大学医学院附属广州红十字会医院消化内科,510220

出　　处：《中华消化内镜杂志》2007年第5期350-353,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的观察经皮内镜下胃空肠造瘘术联合经皮肝穿刺胆管引流术治疗恶性胆道梗阻的效果,探讨其临床意义。方法 9例恶性胆道梗阻患者,均经其他方法治疗未能解除胆道梗阻。按常规方法先行经皮经肝穿刺胆管外引流术(PTCD),1周后采用牵拉法完成经皮内镜下胃造瘘术(PEG)及经皮内镜下空肠造瘘术(PEJ)。在腹壁外将胃空肠造瘘管与 PTCD 引流管相连,经空肠造瘘管将外引流出的胆汁回输入空肠。观察所有患者胆汁引流情况、联合治疗前后临床表现、并发症等。结果 9例患者手术全部成功,PEG/PEJ 用时20～40 min,平均35 min。所有患者胆汁引流管通畅,黄疸明显消退,腹胀、腹痛、腹泻等减轻,进食改善,肝功能明显好转(P<0.01),未见有严重并发症。结论 PEG/PEJ 和 PTCD 联合应用是完全性恶性胆道梗阻的一种新的治疗选择,安全有效。Objective To observe clinical effects of the combination of percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy （PEG/PEJ） and percutaneous transhepatic cholangiodrainage （PTCD） in treating complete malignant obstruction of biliary tract, and discuss its clinical significance. Methods Nine patients with complete malignant obstruction of biliary tract, failed in other therapeutic approaches, were treated with PTCD first. PEG/PEJ was performed one week later. The PEJ tube and PTCD tube were connected out of abdominal wall. The external drained bile was inputted into jejunum again through the PEJ tube. Biliary draining states, patients ＂clinical manifestation＂ before and after combination therapy, as well as complications were recorded. Results PEG/PEJ and PTCD of all 9 patients were successful. The time of PEG/PEJ was 20 - 40 minutes, average 35 minutes. All draining tubes were unobstructed. Jaundice was extincted obviously. Abdominal distension, stomachache, diarrhoea were abated. Appetite and liver function were improved significantly （P 〈 0.01 ）. There was no severe complication. Conclusion The combination of PEG/PEJ and PTCD is a safe and effective therapeutic choice for patients with complete malignant obstruction of biliary tract.

关 键 词：胆管梗阻 引流术 胃造口术 

分 类 号：R735[医药卫生—肿瘤]