恶性梗阻性黄疸介入综合治疗

目的 探讨介入综合治疗恶性梗阻性黄疸的效果及价值.方法 回顾性分析恶性梗阻性黄疸病例109例,其中男54例、女55例,平均年龄(71±12)岁.所有患者经CT和(或)MRI检查结合临床表现诊断为恶性胆道梗阻.先进行经皮肝胆道穿刺,随后置入引流管胆道引流(PTCD)或胆道内支架.术后1周.38病例行肝动脉化疗栓塞(TACE).结果 109例病例均成功穿刺并置入引流管(55例)或植入支架(54例),成功率100%.PTCD及支架引流后血清丙氨酸转氨酶、总胆红素,直接胆红素水平及Child-Pugh分级评分的独立样本t检验,P值分别为0.019、0.002、0.002及0.396.TACE后组间血清丙氨酸转氨酶、总胆红素,直接胆红素水平及Child-Pugh分级评分的独立样本t检验,P值分别为0.834、0.000、0.002及0.002.全组平均生存期26.45(标准误,SE,4.07)周,PTCD及支架治疗的平均生存期分别为28.19(SE,6.54)和21.38(SE,2.51)周(P=0.713);38例行TACE治疗及71例未进一步治疗的平均生存期分别为43.71(SE,8.32)和14.38(SE,2.66)周(P=0.000).不同引流方法在减轻黄疸,改善肝功能,延长生存期方面差异无统计学意义.引流术后,接受了TACE治疗的患者其生存期明显超过未治疗组.结论 胆道支架减轻黄疸的幅度优于PTCD,但黄疸缓解的比例组间无差异;两者短期内对肝功能的改善均无明显作用.在胆道引流术后短期,无论是否行TACE治疗,整体的总体胆红素水平都有继续下降,但行TACE治疗可明显加大胆红素水平下降的幅度,同时能改善整体的肝功能水平.

Long-term outcome of interventional therapy for malignant biliary obstruction: a retrospective analysis of 109 cases

Objective To evaluate the long-term outcome and its relative influenced factors ofinterventional therapy in dealing malignant biliary obstruction (MBO). Method 109 MBO patients, 54males and 55 females, aged (71±12), underwent interventional therapy: 55 patients received percutaneoustranshepatic cholangiography and drainage (PTCD), and 54 underwent bile duct stent implantation. Oneweek later, total bilirubin (TB), direct bilirubin (DB), and alanine transaminase (ALT) were examined,and Child-Pugh scoring was conducted. 38 of the patient underwent transcatheter arterial chemo-embolization(TACE). Results One week after drainage the levels of ALT, TB, and DB of the patients undergoingPTCD and stent implantation all decreased in comparison with those before the treatment, the levels of thestent implantation group being significandy lower than those of the PTCD group ( P = 0. 019, 0.002, and0.002 respectively), but there was no significant difference in Child-Pugh scale between these 2 group (P =0.396). One week after TACE the levels of TB, DB, and Child-Pugh scale of the TACE group were allsignificantly lower than those of the patients without TACE ( P = 0.000, 0.002, and 0.002 respectively),however, there was no significant difference in ALT level between these 2 groups ( P = 0.834 ). Thecumulative mean survival time was 26.45 weeks standard error (SE) 4.07], and the mean survival time ofthe PTCD group was 28.19 weeks( SE,6.54), not significantly different from that of the stenting groups were21.38 weeks( SE,2.51 ) ,P = 0.713 ]. The mean survival time of the TACE group was 43.71 weeks ( SE,8.32), significantly longer than that of the patients without TACE 14.38 weeks ( SE,2.66) ,P =0.000].Conclusion Stenting is more effective than PTCD on relieving jaundice when the decreasing extent ofbilirubin level is concerned. TACE therapy following PTCD and stent implantation will significantly contributeto the survival time of MBO patients.