不同类型高位恶性胆道梗阻的介入治疗  

Interventional Therapy of Hilar Malignant Biliary Obstruction

作　　者：邹建伟[1] 倪才方[1] 刘一之[1] 朱晓黎[1] 金泳海[1] 陈珑[1] 张栋[1] 孙鸽[1] 孙玲芳[1] 

机构地区：[1]苏州大学附属第一医院介入科,215006

出　　处：《临床放射学杂志》2011年第10期1523-1526,共4页Journal of Clinical Radiology

摘　　要：目的评估不同类型高位恶性胆道梗阻介入治疗的方法及价值。资料与方法高位恶性胆道梗阻44例,按Bismuth-Corlette分型:Ⅰ型9例,Ⅱ型13例,Ⅲa型8例,Ⅲb型1例,Ⅳ型13例。在X线透视下以不同方式行胆道引流或支架置入。以术后4周直接胆红素降至正常或下降超过50%为有效作为近期疗效评价标准,并进行随访。结果Ⅰ型、Ⅱ型、Ⅲa型、Ⅳ型有效分别为9例、8例、5例和8例,1例Ⅲb型无效。随访4周～17个月,失访5例。15例完全无黄疸生存;3例复发黄疸;7例有效但持续轻度黄疸生存;3例有效后黄疸再次加深;11例无效。生存时间:≤3个月14例;>3个月≤6个月13例;>6个月<1年8例;≥1年4例。结论经皮肝穿刺引流或内支架治疗仍是治疗高位胆道梗阻的有效姑息方法,有效减黄是提高患者生存的重要因素。Objective To evaluate the effect of interventional therapy hilar malignant biliary obstruction.Materials and Methods Forty four patients with different type of hilar biliary obstruction caused by malignant tumors invasion were selacted.According to Bismuth-Corlette classification,there were 9 cases of type I,13 cases of type II,8 cases of type IIIa,1 cases of type IIIb,and 13 cases of type IV.Biliary drainage or stent planted were underwent guided by X-rays.Except 5 cases lost follow up,the other patients were followed up for 4 weeks to 17 months after therapy.The effective treatment was defined that the level of direct bilirubin decreased more than 50% in 4 weeks.Results Of the 44 patients,there were 9 cases of type I,8 cases of typ II,5 cases of type IIIa,8 cases of type IV showed effective treatment.There was 1 case of type IIIb had no effect.Follow-up period was.There were no jaundice in survival in 15 cases,jaundice recurrence in 3 cases,lower-grade jaundice in survival in 7 cases.Jaundice were aggravated after treatment in 3 case.There were no effective treatment in 11 cases.The survival time was less than 3 months in 14 cases.between 3 months and 6 months in 13 cases,more than 6 months in 8 cases and more than 12 months in 4 cases.Conclusion Biliary drainage and stent planted are safe and effective methods for relieving of billiary obstruction,reducing bilirubin and lengthening the survival time.

关 键 词：梗阻性黄疸 介入 引流 支架 疗效 

分 类 号：R735[医药卫生—肿瘤]