经皮穿刺治疗经内镜引流失败的恶性梗阻性黄疸  

Percutaneous Puncture to Treat Malignant Obstructive Jaundice in Patients Who Fail Endoscopic Drainage

作　　者：谢锋[1] 朱芳[2] 刘峥嵘[3] 王红岩[3] 赵晓丹[3] 樊小刚 

机构地区：[1]中国医科大学人民医院核医学科,沈阳110016 [2]中国医科大学人民医院心功能科,沈阳110016 [3]中国医科大学人民医院普外科,沈阳110016 [4]沈阳出入境检验检疫局国际旅行卫生保健中心,沈阳110016

出　　处：《中国医科大学学报》2018年第2期137-140,共4页Journal of China Medical University

基　　金：辽宁省社会发展公关计划(2013225021)

摘　　要：目的探讨采用经皮经肝胆管穿刺引流术(PTCD)、经皮胆囊穿刺引流术、经皮经肝胆管内支架植入术治疗经内镜引流失败的恶性梗阻性黄疸的临床应用价值。方法回顾性分析2015年8月至2017年7月行经内镜减黄失败后在我院行经皮穿刺减黄的梗阻性黄疸患者共17例。根据病变类型及术中情况选择不同的减黄方法,其中9例行经皮经肝胆管内支架植入术(53%)、5例行PTCD(29%)、3例行经皮胆囊穿刺引流术(18%)。采集术前1 d及术后1周患者的总胆红素和谷丙转氨酶,以二者手术前后的下降程度来评价经皮穿刺减黄治疗的效果;再以是否放置支架为条件,将患者分为支架组和置管组,以总胆红素、谷丙转氨酶的下降程度及患者生存期来评价2组的疗效差异。结果总体患者手术前后总胆红素及谷丙转氨酶均有明显下降(P<0.05)。支架组和置管组总胆红素、谷丙转氨酶的下降程度都没有明显差异(P>0.05)。支架组患者的生存期长于置管组,2组比较有统计学差异(P<0.05)。结论经皮穿刺治疗经内镜引流失败的恶性梗阻性黄疸疗效确切。相对于留置引流管,放置支架可以更好的延长患者生存期。而对于总胆红素、谷丙转氨酶的下降方面,放置支架并不优于留置引流管。Objective To study the efficacy of percutaneous transhepatic cholangiodrainage （PTCD） ,percutaneous gallbladder drain- age,and percutaneous transhepatic biliary stent implantation for the treatment of malignant obstructive jaundice in patients who are observed to fail endoscopic drainage. Methods We retrospectively analyzed 17 patients diagnosed with obstructive jaundice between August 2015 and July 2017 who were observed to have failed endoscopic drainage. Percutaneous puncture drainage had been performed in all patients-different methods were chosen based on the type of lesion and the patient＇ s intraoperative condition. Among these patients, 9 underwent percutaneous transhepatic biliary stent implantation （53%） , 5 underwent PTCD （29%） ,and 3 underwent percutaneous gallbladder drainage （18%）. The serum levels of total bilirubin （TBIL） and alanine aminotransferase （ALT） were assessed a day pre- operatively and a week postoperatively. The postoperative decrease （or drop） in the serum TBIL and ALT levels was used as a parameter to assess the efficacy of treatment. Patients were divided into a stent and a tube group. The therapeutic effects were compared between the groups in terms of the drop in the serum TBIL and ALT levels and the survival time of patients. Results The postoperative serum TBIL and ALT levels were significantly decreased in all patients （P 〈 0.05）. No statistically significant difference was observed between the stent and the tube group in terms of the decrease in serum TBIL and ALT levels （P 〉 0.05）. However, a statistically significant difference was observed between the stent and the tube group in terms of the survival time of patients （P 〈 0.05）. Conclusion Percutaneous punc- ture is an effective treatment modality to manage malignant obstructive jaundice in patients who fail endoscopic drainage. Compared to tube drainage, stent placement can prolong patient survival time. Regarding the decrease in serum TBIL and ALT levels, we conclude that st

关 键 词：梗阻性黄疸 经皮经肝胆管内支架植入术 经皮经肝胆管引流术 经皮胆囊穿刺引流术 

分 类 号：R45[医药卫生—治疗学]