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[目的]探讨经皮肝穿刺胆道引流及支架置入术治疗恶性胆道梗阻的临床疗效及经验。[方法]在DSA下对31例恶性胆道梗阻患者先行经皮肝穿刺胆道造影(PTC)了解狭窄部位和长度。如导丝不能越过狭窄段,则行外引流术;如能越过狭窄段,则行支架置入术。[结果]31例患者中4例单纯外引流,25例单支架置入,2例双支架置入。术前血清总胆红素249.6±89.1μmol/L,术后2周与1个月血清总胆红素分别下降到108.7±36.2μmol/L与55.6±16.5μmol/L(P<0.01),碱性磷酸酶与丙氨酸转氨酶下降明显(P均<0.01)。4例单纯外引流中3例于术后1个月内死亡。出现并发症9例(29%)。生存6个月21例,生存12个月13例,生存18个月4例。[结论]经皮胆道引流及支架置入术是姑息性治疗恶性胆道梗阻的有效方法。
[Objective] To investigate the clinical efficacy and experience of percutaneous transhepatic biliary drainage and stent implantation in the treatment of malignant biliary obstruction. [Method] Percutaneous transhepatic cholangiography (PTC) was performed in 31 patients with malignant biliary obstruction under DSA to understand the location and length of stenosis. If the guide wire can not cross the narrow section, then the line drainage; if it can cross the narrow section, the line stent placement. [Results] Among the 31 patients, 4 cases were treated by external drainage alone, 25 cases were treated with single stent and 2 cases were treated with double stent. Preoperative serum total bilirubin 249.6 ± 89.1μmol / L, serum total bilirubin decreased to 108.7 ± 36.2μmol / L and 55.6 ± 16.5μmol / L (P <0.01) after 2 weeks and 1 month The levels of phosphatase and alanine aminotransferase decreased significantly (all P <0.01). In 4 cases of simple extradural drainage in 3 cases died within 1 month after operation. Complications occurred in 9 cases (29%). 21 cases survived 6 months, 13 cases survived 12 months and 4 cases survived 18 months. [Conclusion] Percutaneous biliary drainage and stent implantation are effective methods for palliative treatment of malignant biliary obstruction.