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目的：经皮肝穿肝胆管内置入金属支架治疗恶性胆管梗阻并探讨其技术要点和影响疗效的因素。方法：５７例恶性胆管梗阻，采用经皮肝穿刺肝管胆道内金属支架置入术，胆管癌２５例，胰头癌９例，肝癌１５例，胃癌转移８例。阻塞部位位于胆总管３３例；肝门部２４例，其中肝总管１３例，累及右肝管５例，左、右肝管６例。结果：共置入４种类型金属支架６５枚，９例病人置入双内支架。技术操作成功率９８．２％。术前血清胆红素１６２．７～９６０．４μｍｏｌ／ｌ，术后５３例降至１８．３～５５．６μｍｏｌ／ｌ。半年生存率７５．４％ （４３／５７），一年生存率４７．４％（２７／５７）。支架置入后半年再阻塞率４３．９％ （２５／５７）。结论：经皮肝穿胆道内支架置入术治疗恶性胆管梗阻安全、有效，是临床重要姑息性治疗手段，支架再阻塞是影响远期疗效的重要因素。
Objective: Percutaneous transhepatic biliary ducts embedded with metal stent in the treatment of malignant biliary obstruction and to explore its technical features and factors that affect the efficacy. Methods: Fifty-seven patients with malignant biliary obstruction were treated with percutaneous transhepatic hepatic duct biliary stent implantation. There were 25 cases of cholangiocarcinoma, 9 cases of pancreatic head cancer, 15 cases of hepatocellular carcinoma and 8 cases of gastric carcinoma metastasis. Obstruction in the common bile duct in 33 cases; hilar 24 cases, including 13 cases of hepatic duct, involving the right hepatic duct in 5 cases, left and right hepatic duct in 6 cases. Results: A total of 65 types of metal stents were placed in 4 types and 9 patients were placed in double stents. Technical operation success rate of 98.2%. Preoperative serum bilirubin 162.7 ~ 960.4μmol / l, after 53 cases reduced to 18.3 ~ 55.6μmol / l. The half-year survival rate was 75.4% (43/57) and the one-year survival rate was 47.4% (27/57). Six months after stent placement, the rate of reocclusion was 43.9% (25/57). Conclusion: Percutaneous transhepatic biliary stent implantation is safe and effective in treating malignant biliary obstruction. It is an important palliative treatment in clinic. Re-occlusion of stent is an important factor affecting long-term efficacy.