肝癌合并胆管癌栓经皮介入引流治疗的临床疗效观察  

Clinical application of percutanously interventional therapeusis in patients with hepatocellular carcinoma accompanied with bile duct thrombosis

作　　者：卢再鸣[1] 梁宏元[1] 孙巍[1] 温锋[1] 毛晓楠[1] 郭启勇[1] 

机构地区：[1]中国医科大学附属盛京医院放射科,沈阳110004

出　　处：《中华放射学杂志》2010年第3期303-307,共5页Chinese Journal of Radiology

基　　金：辽宁省教育厅创新团队基金资助项目（2007T182）

摘　　要：目的探讨经皮介入治疗肝癌合并胆管癌栓致梗阻性黄疸的方法和临床价值。方法回顾性分析16例经病理及影像检查证实为肝癌合并胆管癌栓造成梗阻性黄疸的患者资料，16例均行经皮穿刺造影后置管引流术，根据患者置管后的临床表现，分别采用永久性外引流、内引流定期调整引流管以及覆膜支架植入等治疗方法，术后检测血清总胆红素（TBIL）水平，并采用配对t检验与术前对比，根据TBIL下降情况及临床症状缓解情况来评价治疗的有效性，并在2年的随访期限内观察患者生存期。结果16例穿刺引流均获得成功，其中永久性外引流2例，内引流并定期调管7例，留置覆膜支架7例。16例经皮介入治疗前总胆红素平均为（261．9±77．2）μmol／L，治疗后2周为（161．2±80．5）μmol／L，差异有统计学意义（t=7．366，P〈0．01）。16例生存时间为30～391d，平均生存时间204d，中位生存时间为200d。穿刺引流的主要并发症为出血和感染，经止血及抗炎等常规治疗可有效控制。结论对于肝癌合并胆管癌栓所致的梗阻性黄疸，经皮介入治疗技术成功率高，临床疗效较好。Objective To explore the method and value of percutanously interventional therapeusis for treatment of obstructive jaundice caused by hepatocellular carcinoma accompanied with bile duct thrombosis. Methods Sixteen cases with bile duct thrombosis proved by pathology and imaging examinations were retrospectively analyzed. According to the clinical symptoms, all the patients received percutaneous transhepatic biliary drainage （PTBD） including permanent external drainage, temporary internal drainage and implantation of covered stents. Serum total bilirubin （TBIL）after the interventional therapeusis were measured and compared with that before the treatments by t test to evaluate the efficacy of these treatments. The relief of clinical symptoms was also reviewed to evaluate the efficacy of these treatments. The patients were followed up within 2 years. Results The PTBD was successfully performed in 16 cases. Permanent external drainage, temporary internal drainage and implantation of covered stents were performed in 2 patients, 7 patients and 7 patients respectively. TBIL after the interventional therapy decreased significantly （ t = 7. 366, P 〈 0. 01 ） to （ 161.2 ± 80. 5 ） bmol/L averagely from （ 261.9 ±77. 2）μmoL/L before the treatments. All the patients died before the end of followed-up. The average survival time was 204 days（30 to 391 d）and the median survival time was 200 days. Bleeding and infection were the main complications, which could be controlled successfully by routine treatments. Conclusion With high achievement ratio and good efficacy, percutanously interventional therapeusis are good choices for the treatments of obstructive jaundice due to bile duct thrombosis.

关 键 词：肝肿瘤 胆管肿瘤 肿瘤循环细胞 放射学 介入性 

分 类 号：R735.7[医药卫生—肿瘤]