改良经皮肝穿刺胆道引流术及经皮胆道支架置入治疗恶性梗阻性黄疸  

Management of malignant obstructive jaundice by improved PTCD and percutaneous biliary tract stents placement

作　　者：刘会春[1] 李宗狂[1] 周磊[1] 鲁贻民[1] 周少波[1] 

机构地区：[1]蚌埠医学院附属医院肝胆外科,安徽省蚌埠233004

出　　处：《中国基层医药》2008年第12期1937-1938,共2页Chinese Journal of Primary Medicine and Pharmacy

基　　金：安徽省卫生厅应用技术项目（068095）

摘　　要：目的探讨改良经皮肝穿刺胆道引流术（PTCD）及经皮胆道支架置人在恶性梗阻性黄疸中的治疗价值。方法33例恶性胆道梗阻患者，采用改良PTCD，并在当时或1—3周后行经皮胆道可膨式金属支架置人。结果改良PTCD成功率100％，支架置入成功率90．9％（30／33）。随访1—29个月，中位生存14．8个月。6例随访期间出现发热、黄疸，其中1例重置PTCD后症状缓解，1例抗炎、利胆治疗后症状消失，1例重置PTCD管后黄疸短暂消失，渐出现混合性黄疸，另3例因肿瘤广泛浸润、转移、恶病质，不宜再次PTCD引流。结论（1）经皮胆道支架置入术的选择性应用，是姑息性治疗恶性梗阻性黄疸的安全有效方法，并能原位恢复胆道的生理连续性；（2）改良PTCD操作是支架置入的前提条件和放置失败的引流保证，也为胆道再梗阻提供了解决的途径。Objective To investigate the clinical value of improved percutaneous transhepatic eholangiographic drainage（PTCD） and pereutaneous placement of biliary metallic stents on the treatment of malignant obstructive jaundice. Methods Thirty three patients with malignant biliary obstruction were treated by the improved PTCD guided by ultrasound followed by percutaneous placement of biliary tract metallic stents 1 - 3 weeks later. Results Improved PTCD was succeeded in all the patients,30 patients （90. 9% ） accepted pereutaneous placement of biliary metallic stents successfully,3 patients who failed in stents placement accepted PTCD again for palliative management of jaundice. Those who failed in stent placement were found to have bleeding from the PTCD tube, but recovered several days later. Jaundice alleviated in all the patients. The patients were followed up for 1 - 29 months, medium follow-up period is 14.8 months. Six cases were found fever and jaundice, among that, two accepted improved PTCD again, one recovered after antibiotic treatment, the remaining 3 patients failed in further treatment due to the metastasis of the tumor. Conclusion Percutaneous placement of biliary metallic stents after improved PTCD is a safe and effective method to relieve malignant biliary obstruction,it can improve life quality, prolong survival time. This method could be a good choice for treating the patients with malignant biliary obstruction without operation.

关 键 词：胆道梗阻 支架置入 经皮肝穿刺胆道引流术 

分 类 号：R730[医药卫生—肿瘤]