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目的探讨介入微创法经皮经肝胆管引流术(PTBD)及经皮经肝胆管支架置入术(PTBS)姑息性治疗恶性梗阻性黄疸的方法及临床应用价值。方法对56例恶性梗阻性黄疸患者均进行介入微创引流(PTBD或PTBS)治疗,男32例,女24例,年龄44～76岁,平均62.7岁。胆道梗阻部位位于胆总管21例,位于肝门部35例。梗阻的原因包括胰头癌(包括壶腹癌)12例,胆管癌24例,转移癌18例,胆囊癌2例。结果介入微创引流术穿刺成功率为100%。本组患者中行PTBD38例,行PTBS18例,术后3d黄疸均有好转,术后1周血清总胆红素平均为(221.3±131.7)μmol/L,较术前明显下降(P<0.001),其中30例胆红素明显下降(百分比>50%),26例胆红素有所下降(下降百分比25%～50%)。并发症发生率为5.3%,包括引流管阻塞1例,引流管移位1例,支架阻塞1例,经再次行PTBD缓解。结论介入微创引流术(PTBD和PTBS)是姑息性治疗恶性梗阻性黄疸的简单、有效的方法,具有较高的临床应用价值。
Objective To investigate the method of palliative treatment of malignant obstructive jaundice with minimally invasive percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic biliary stenting (PTBS) and its clinical value. Methods 56 patients with malignant obstructive jaundice were treated by minimally invasive drainage (PTBD or PTBS), 32 males and 24 females, aged 44 to 76 years (average 62.7 years). Biliary tract obstruction in the common bile duct in 21 cases, located in 35 cases of hilar. Causes of obstruction include pancreatic cancer (including ampullary carcinoma) in 12 cases, 24 cases of cholangiocarcinoma, 18 cases of metastatic cancer, gallbladder cancer in 2 cases. Results minimally invasive drainage puncture success rate was 100%. The patients underwent PTBD in 38 cases, PTBS in 18 cases and postoperative jaundice in 3 days. The serum total bilirubin was (221.3 ± 131.7) μmol / L at 1 week after operation, which was significantly lower than that before operation (P <0.001) Among them, 30 cases of bilirubin decreased significantly (percentage> 50%) and 26 cases of bilirubin decreased (25% -50% decrease). Complication rate was 5.3%, including drainage tube obstruction in 1 case, drainage tube displacement in 1 case and stent occlusion in 1 case. PTBD remission was performed again. Conclusions Interventional minimally invasive drainage (PTBD and PTBS) is a simple and effective method for palliative treatment of malignant obstructive jaundice, and has high clinical value.