恶性梗阻性黄疸的双介入治疗  

Dual Interventional Treatment of Malignant Obstructive Jaundice:Combined Percutaneous Transhepatic Biliary Drainage and Transarterial Chemotherapy

作　　者：王小林[1] 董永华[1] 龚高全 

机构地区：[1]上海医科大学中山医院放射科,200032 [2]美国俄亥俄州克利夫兰医疗中心临床基础放射

出　　处：《介入放射学杂志》1998年第4期207-210,共4页Journal of Interventional Radiology

摘　　要：目的:本文通过双介入法(经皮经肝胆道引流术和经动脉化疗栓塞术)在恶性梗阻性黄疸病人治疗中的研究,对双介入法作一评价。材料和方法:我院从1987年至1996年共有82例恶性梗阻性黄疸病人接受了介入治疗。其中28例为单纯的经皮经肝胆道引流术(PTBD),归为 A 组;另外54例在 PTBD 术后2周左右接受了经动脉化疗术(TAI)和/或化疗栓塞术(TAI+TAE),归为 B 组。所有病人都通过多种影象学,外科或生物活检诊断为恶性梗阻性黄疸。所有的病人均获随访。两组疗效进行比较。结果:在 PTBD 术后15～20天内,所有病人血清胆红素水平明显下降,肝功能好转。A 组病人,中位生存期为3.6个月,均无胆道梗阻再通。B 组,中位生存期为10.2个月,其中31例(57.4%)在2～4次 TAI 和/或 TAE 后显示胆道梗阻再通。其中9例在拔除引流管后5～51个月中无黄疸出现。两组的并发症差别无统计学意义。结论:对于恶性梗阻性黄疸病人,PTBD 结合 TAI 和/或 TAE 是安全、有效的治疗方法。与单纯 PTBD 相比较,双介入法能改善病人的生活质量并提高生存率。它还可以提供更方便的途径来置放胆道金属内支架。Objective:The purpose of this study was to evaluate the role of the combination of percutaneous transhepatic biliary drainage(PTBD)and the transarterial chemotherapy for the treatment of malignant obstructive jaundice.Materials and Methods:From 1987 June to 1996 June,total 82 cases of malignant obstructive jaundice were successfully treated by the combined method,of 28 cases were treated by PTBD alone(group A),and another 54 cases were received the transarterial infusion chemotherapy or/and chemoembolization about two weeks after the PTBD(group B).All patients were diagnosed to be advanced malignant tumor by multiple imagings,surgery as well as biopsy.All patients had been followed up.The efficacies of the two groups were compared.Results:After PTBD,serum bilirubin level in all patients were remarkably declined and liver function recovered within 15-20 days.In group A, mean survival period was 3.6 months,and no patient lived longer than 6 months without recanalization of biliary obstruction.In group B,mean survival period was 10.2 months with recanalization of biliary obstruction shown in 31 cases(57.4%)following 2-4 times of TAI and/or TAE.9 of those cases were free of jaundice for 5-51 months after withdrawn of drainage catheter.No significant difference between the 2 groups in complications.Conclusion:PTBD combined with transarterial chemotherapy is a safe and effective method for the treatment of malignant obstructive jaundice.Comparing the efficiency of PTBD alone,it can improve pa- tients' life quality and raise the survival rate.It may provide more easy approach to implant the biliary metal stent.

关 键 词：胆道肿瘤 胆道引流 梗阻性黄疸 栓塞化疗 

分 类 号：R735.805[医药卫生—肿瘤] R575.05[医药卫生—临床医学]