目的观察PTCD(经皮肝穿刺胆管外引流术)联合胃镜引导经皮胃造瘘内引流治疗梗阻性黄疸的效果,探讨其临床意义。方法不能手术治疗的恶性胆道梗阻黄疸患者20例,分为2组,PTCD联合胃造瘘内引流术组(n=10),PTCD组(n=10)。PTCD联合胃造瘘内引流术组先行PTCD,再胃镜引导经皮胃造瘘术,在腹壁外与PTCD引流管相连接,将外引流出的胆汁回输至十二指肠内。观察患者临床表现、并发症、生存期(月)、生活质量和胆汁引流情况。结果手术全部成功,与PTCD组比较,PTCD联合胃造瘘内引流术组患者胆汁引流管通畅,黄疸明显消退,腹胀、腹痛、腹泻等减轻,进食改善,肝功能明显好转,生活质量明显提高(P<0.05)。结论 PTCD联合胃镜引导经皮胃造瘘内引流是恶性胆道梗阻性黄疸的一种新的治疗方法,安全有效,可作为晚期或不能切除胆管癌的姑息性治疗方法,并为其它姑息性治疗(放疗、化疗)创造条件。 Objective To observe the effect of PTCD (percutaneous transhepatic cholangiopancreatography) combined with endoscopic percutaneous gastrostomy drainage in the treatment of obstructive jaundice, and to explore its clinical significance. Methods Twenty patients with malignant biliary obstructive jaundice who could not be surgically treated were divided into two groups: PTCD group (n = 10) and PTCD group (n = 10). PTCD combined gastrostomy drainage group first PTCD, and then gastroscope guided percutaneous gastrostomy in the abdominal wall connected with the PTCD drainage tube, the drainage of the bile delivered to the duodenum. The clinical manifestations, complications, survival (months), quality of life and bile drainage were observed. Results All the operations were successful. Compared with PTCD group, the biliary drainage tube in patients with PTCD combined with intragastric fistula drainage was significantly relieved, jaundice was obviously relieved, abdominal distension, abdominal pain and diarrhea were relieved. The improvement of eating, liver function and quality of life were significantly improved P <0.05). Conclusion PTCD combined with gastroscopic guided percutaneous gastrostomy drainage is a new treatment of malignant biliary obstructive jaundice, safe and effective, can be used as palliative treatment of advanced or unresectable cholangiocarcinoma, and for other palliative treatment ( Radiotherapy, chemotherapy) to create conditions.