PTCD途径胆道金属支架置入术治疗晚期胰头癌的疗效观察  

The clinical observation of percutaneous biliary metal stent implantation for unresectable pancreatic cancer

作　　者：王哲近[1] 陈海川[1] 俞海波[1] 

机构地区：[1]温州市中心医院/温州医科大学定理临床学院肝胆外科,浙江温州325000

出　　处：《肝胆胰外科杂志》2015年第6期494-496,501,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨不能手术切除的胰头癌患者行PTCD途径胆道金属支架置入术的临床疗效。方法回顾性分析我院2009年7月至2014年6月36例资料完整、失去手术切除时机的晚期胰头癌患者的临床资料,所有患者先在B超引导下行经皮经肝胆管穿刺引术(PTCD),术后1周在DSA下行经皮胆道金属支架植入术。术后1周、1个月、3个月检测血肝功能水平,即血清白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL),并观察黄疸消退情况、支架通畅时间、生存期。采用重复测量的方差分析方法比较术前与术后肝功能指标水平变化情况。结果 36例患者经治疗后黄疸消退明显,一般身体状况明显改善。术后1周ALT、AST、TBIL、DBIL较术前降低,差异有统计学意义(P均<0.01);术后1、3个月肝功能各指标水平较术后1周降低,差异有统计学意义(P均<0.01),但术后1个月和3个月间的各指标水平比较,差异无统计学意义(P均>0.05)。平均支架通畅时间为(7.65±0.95)个月,术后平均生存时间(8.25±1.35)个月。结论 PTCD途径胆道金属支架置入具有操作简便、安全、创伤小、可重复性以及可为后续的治疗创造条件等优点;其可解除胆道梗阻,改善患者全身状况,尤其适用于高龄、身体状况差、失去手术切除机会的胰头癌患者。Objective To explore the clinical effects of percutaneous biliary metal stent implantation for unresectable pancreatic head carcinoma. Methods A retrospective study was performed on 36 cases of patients with unresectable pancreatic head carcinoma from Jul. 2009 to Jun. 2014 in our hospital. All the patients were conducted to percutaneous transhepatic cholangial drainage （PTCD） under the B-type ultrasound guidance. After 1 week, metal biliary stent were placed via DSA leading. All patients＇ routine biochemical indexes were tested in 1 week, 1 and 3 mon after the procedure. The jaundice situation, the time length of stent patency and survival periods were also observed. Repeated measures analysis of variance was performed to compare the difference of liver function indexes pre- and post- operation. Results The general physical condition markedly improved and the symptoms of jaundice significantly decreased in the 36 metal stent implantation. One week after operation, the level patients after the treatment of percutaneous biliary of alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBIL）, direct bilirubin （DBIL） were significantly lower than those preoperative （P〈0.01）; the levels of liver function in 1 and 3 mon after operation were significantly lower than those in l week after operation （P〈0.01）, but there was no significant difference between 1 and 3 mon after operation （P〉0.05）. The average time of stent patency were （7.65±0.95） mon. Kaplan-Meier survival curve analysis showed that the average survival time were （8.25±1.35） mon. Conclusion Percutaneous metal biliary stent implantation is a simple, safe, minimally invasive and repeatable treatment, which can relieve biliary obstruction and improve the general condition. It should be the first choice for elder patients with unresectable pancreatic head carcinoma.

关 键 词：胰头癌 经皮经肝胆管引流 梗阻性黄疸 

分 类 号：R735.9[医药卫生—肿瘤]