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目的 回顾性分析介入性经皮胆道内引流治疗恶性梗阻性黄疸的疗效。方法 对 43例患者采用经皮肝穿刺胆道内引流治疗恶性梗阻性黄疸 ,内引流方式有内外引流管、金属内支架或塑料内涵管。结果 单纯内引流者 2 8例 ,2 5例置入金属支架 ,3例置入塑料内涵管 ;置入内外引流管者有 15例。术后 1周血清总胆红素 (TBIL)从术前的 5 0 1 6± 198 4μmol/L降至 2 30 7±138 5 μmol/L(P <0 0 0 1) ,碱性磷酸酶与丙氨酸转氨酶均下降明显 (P均 <0 0 0 1)。 3例于术后 1个月内死亡 ,均与胆道引流无直接因果关系。跟踪随访 36例 ,平均随访 5 9个月 ,7例仍存活 ,2 3例(6 3 9% )总胆红素降至正常范围。结论 经皮肝穿刺胆道内引流术是对恶性梗阻性黄疸的一种安全、有效的姑息性治疗方法 ,可明显缓解黄疸、减轻痛苦、提高生存质量 ,并可改善肝脏功能 ,有限地延长患者生存时间。
Objective To retrospectively analyze the effect of interventional percutaneous biliary drainage in the treatment of malignant obstructive jaundice. Methods Forty - three patients underwent percutaneous transhepatic biliary drainage for the treatment of malignant obstructive jaundice. There were internal and external drainage catheters, metal stent or plastic intension tube in internal drainage. Results There were 28 cases of purely internal drainage, 25 cases were placed in metal stents, 3 cases were placed in plastic culverts, and 15 cases were placed inside and outside the drainage tube. The level of serum total bilirubin (TBIL) decreased from 5 0 1 6 ± 198 4 μmol / L preoperatively to 2 30 7 ± 1 98 5 μmol / L (P 0 01 0) Alanine aminotransferase decreased significantly (P all <0 0 0 1). Three patients died within 1 month after operation and had no direct causal relationship with biliary drainage. Totally 36 follow-up cases were followed up for a mean follow-up of 59 months. Seven patients survived, and 23 (63.9%) total bilirubin was reduced to the normal range. Conclusion Percutaneous transhepatic biliary drainage is a safe and effective palliative treatment for malignant obstructive jaundice. It can relieve jaundice, relieve pain, improve quality of life, improve liver function and prolong patient survival time.