PTC下胆道活检诊断恶性阻塞性黄疸的临床应用

目的：探索PTC下胆道活检的可行性和敏感性，获取病变胆管的组织病理学，指导临床治疗。方法：19例恶性阻塞性黄疸，在行PTCD（经皮经肝穿刺胆道内外引流术）减黄术中，PTC下胆道活检，进行组织病理学检查。结果：19例患者中有18例获得组织病理学诊断（敏感性，94.74％）。病理报告为胆管癌n=13，胰腺癌n=2，转移瘤=2,，肝细胞癌n=1，阴性结果n=1，阳性结果率为94.74％。结论：PTC胆道活检是一种准确可靠的获取组织病理学检查途径。     

螺旋CT胆道造影术在疑诊阻塞性黄疸患者中的应用

目的　探讨螺旋CT胆道造影术 (SCTC)在疑诊为阻塞性黄疸患者中的应用价值和限度。方法　 5 9例临床疑诊为阻塞性黄疸患者行螺旋CT检查 ,有 2 9例因血清总胆红素 (T Bil) >34μmol L ,估计其胆道难以显影而被排除 ;另 30例用 5 0 %胆影葡胺作为静脉胆道对比剂 ,进行SCTC。采用横断面图像、多平面重建和容积重建 3种方法 ,分析胆管树显影分级 (1～ 5级 )、总分级 (以同例 3种方法中最高级为准 )与胆管阻塞程度和水平、T Bil、直接胆红素 (D Bil)、丙氨酸转氨酶 (ALT)的关系以及图像质量。结果　胆管树分级在横断面图像、多平面重建和容积重建 3种方法间的差异均无显著性 (P >0 .0 5 ) ,4级和 5级之和分别占 86 .7% (2 6例 )、73.3% (2 2例 )和 86 .7% (2 6例 ) ;总分级与D Bil、ALT、阻塞程度有相关性 (rs=- 0 .719,- 0 .5 4 4 ,0 .6 5 0 ) ,而与T Bil和阻塞水平无相关性 (rs =- 0 .2 5 3,0 .2 6 1) ;图像质量在横断面图像与多平面重建之间差异有显著性 (P =0 .0 34) ,图像质量很好者在横断面图像、多平面重建和容积重建中分别占 93.3% (2 8例 )、6 6 .7% (2 0例 )和 70 .0 % (2 1例 )。结论　SCTC在经选择的疑诊为阻塞性黄疸的患者中具有一定的应用价值。     

经皮肝穿刺胆道内支架引流术治疗恶性阻塞性黄疸21例疗效分析

恶性阻塞性黄疸多由胆管癌、胰腺癌、胆囊癌、转移性肿瘤引起，病情日益加重可引起肝、肾功能衰竭。因此，减黄的治疗措施是十分必要的。目前的减黄治疗手段通常是经手术或介入方法进行各种内外引流术。2003年3月-2004年12月，本院共对21例不能手术的恶性阻塞性黄疸患者成功进行了经皮肝穿刺胆道内支架引流术减黄治疗，治疗后绝大部分患者病情缓解，取得了较好效果.     

单通道双国产胆道支架在恶性高位梗阻性黄疸的临床应用

目的 探讨肝门部恶性梗阻性黄疸单侧穿刺单通道双胆道国产支架引流的疗效、安全性。方法 回顾性分析哈尔滨医科大学附属肿瘤医院2012年10月-2013年12月收治24例肝门部高位恶性梗阻性黄疸患者临床资料,每例患者均接受双国产胆道支架治疗。其中采用单通道双支架治疗9例(试验组),采用双侧通道双支架15例(对照组);比较两组的术中穿刺肝管次数、辐射曝露剂量、操作时间、引流有效率及并发症发生率。结果 试验组穿刺肝管平均1.44±0.53次,明显低于对照组3.73±0.70次,差异有统计学意义(P＜0.01)。试验组透视下操作时间、辐射曝露剂量平均为(1152.22±335.61)s、(653.22±207.02)mGy,略低于对照组(1236.93±463.43)s、(727.00±348.52)mGy,差异无统计学意义(P＜0.05)。4周后复查肝功,试验组与对照组引流有效率分别为88.9%(8/9)、86.7%(13/15),差异无统计学意义(P=1.00)。试验组有1例胆汁渗出,对照组有2例胆道出血,两组均无严重并发症发生。结论 单通道双国产胆道支架减黄治疗损伤小、疗效确切,可选择性应用于治疗肝门区梗阻性黄疸患者。     

经皮肝穿刺胆道造影对恶性梗阻性黄疸病因诊断价值的探讨

本文报告２４例恶性梗阻性黄疸，其中肝门区癌２例，胰头癌１１例，胆管癌７例，壶腹癌３例．原发性十二指肠腺癌１例。在术前作Ｂ超和ＰＴＣ检查，对梗阻的部位、范围、程度、性质和病因诊断等临床资料进行对照分析，Ｂ超和ＰＴＣ诊断与手术和病理学诊断的符合率分别为５４％和９１．６％。结果表明，ＰＴＣ对恶性梗阻性黄疸术前病因诊断的正确率明显高于Ｂ超，其操作方法简便安全，更适合于基层医院应用。     

PTCD联合胆道支架置入术治疗恶性梗阻性黄疸的护理

总结26例经皮肝穿刺胆道引流术(PTCD)联合胆道支架置入术治疗恶性梗阻性黄疸的护理。术前加强心理护理、皮肤护理,术中密切观察、熟练配合,术后加强电解质紊乱的观察、引流管护理以及并发症的观察与护理。本组患者均顺利完成手术,肝功能恢复良好,术后并发胆道感染、急性胰腺炎、胆漏、胆道出血各1例,胆道支架移位和堵塞再狭窄各1例,其余患者均康复出院。     

经皮肝穿胆道支架置入治疗恶性胆道梗阻的临床研究

目的：总结经皮肝穿刺胆道金属内支架植入治疗恶性胆道梗阻的临床疗效及经验。方法：92例恶性胆道梗阻性黄疸患者,采用经皮肝穿刺肝胆管支架置入术。根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式。结果：92例患者中,91例胆道支架成功放置,其中12例放置双支架,支架扩张良好,引流通畅,血清胆红素下降明显。术后死亡2例,胆道出血3例,腹水渗漏6例,胆漏2例,支架移位1例,胆管炎9例,胆道再阻塞11例。结论对不能手术的恶性胆道梗阻性黄疸患者,经皮肝穿刺胆道内支架植入术创伤小,可提高患者的生存质量,延长生存期,是一种较为安全、有效的方法。     

经皮肝穿胆道支架置入治疗恶性胆道梗阻的临床研究

目的:总结经皮肝穿刺胆道金属内支架植入治疗恶性胆道梗阻的临床疗效及经验.方法: 92例恶性胆道梗阻性黄疸患者,采用经皮肝穿刺肝胆管支架置入术.根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式.结果: 92 例患者中,91例胆道支架成功放置,其中12例放置双支架,支架扩张良好,引流通畅,血清胆红素下降明显.术后死亡2例,胆道出血3例,腹水渗漏6例,胆漏2例,支架移位1例,胆管炎9例,胆道再阻塞11例.结论对不能手术的恶性胆道梗阻性黄疸患者,经皮肝穿刺胆道内支架植入术创伤小,可提高患者的生存质量,延长生存期,是一种较为安全、有效的方法.     

胆道支架置入术联合三维适形放疗治疗恶性阻塞性黄疸的临床研究

目的探讨胆道支架置入术联合三维适形放疗治疗恶性梗阻性黄疸的疗效。方法对不能手术切除的恶性阻塞性黄疸患者50例,先行胆道支架引流术,再行三维适形放射治疗。观察患者胆红素消退、支架畅通情况、近期疗效、生存时间和生存率。结果经过联合治疗后,患者黄疸症状均改善明显,血清胆红素明显下降(P<0.01),肿瘤有效率(PR+CR)为90.0%(45/50)。1年和2年的累积生存率分别为60.0%和11.8%,中位生存时间13个月。结论对不能手术的恶性阻塞性黄疸患者采取胆道支架置入术后联合三维适形放疗能够改善症状,提高患者生活质量,延长生存时间,是一个安全有效的治疗方法。     

超声检查在胆道下段阻塞性黄疸恶性病变中的应用价值

目的：探讨二维、彩色多普勒及超声造影技术在胆道下段阻塞性黄疸恶性病变中的声像图特征。方法：应用二维、彩色多普勒及超声造影技术对经病理证实的88例胆道下段阻塞性黄疸恶性病变即胰腺癌、胆管癌、壶腹癌患者观察其胆总管梗阻的程度、胰管增宽情况及肿瘤位置、大小形态、包膜边界、内部结构、血流状况等图像特征。胰腺癌中6例胰头癌患者进行超声造影。结果：88例恶性肿瘤患者中胰腺癌39例,胆管癌18例,壶腹癌31例。声像图特征：胆道下段阻塞性黄疸恶性病变均有肝内外胆管扩张、胆囊正常或增大、胰管扩张。胰腺癌包括胰头癌35例、胰体癌2例及胰尾癌2例,可有大小不等肿瘤,周围血流包绕。超声造影胰腺癌肿瘤本身与周围胰腺组织相比,表现出略低于正常胰腺的增强强度模式,时相呈典型低增强,造影剂充填分布不均,廓清时间早于正常胰腺组织,肿瘤病灶的大小和边界以及与胰腺周围动静脉的关系显示更清晰。胆管癌18例中,截断型2例,肿块型5例,漏斗型11例。壶腹癌31例。误诊8例：胰腺癌4例漏诊,胆管癌2例误诊,壶腹癌2例漏诊,诊断符合率为90．9％（80／88）。全部经病理证实。结论：引起胆道下段阻塞性黄疸之恶性肿瘤二维及彩色多普勒声像图根据其特征可作出诊断,对不典型图像还可采用超声造影技术进行确诊,有利于临床治疗方案的制定和术后疗效的评估。     

Internal-External Percutaneous Transhepatic Biliary Drainage for Patients with Malignant Obstructive Jaundice

Purpose: To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD)for patients with malignant obstructive jaundice. Methods: During the period of January 2008 and July 2013,internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During theprocedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed.External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degreeof bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect ofIEPTBD. Results: Twenty newly onset of infection were recorded after procedure and new infectious rate was47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 ofthem (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L beforedrainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp(P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P< 0.05). Conclusions: The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainageefficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients withmalignant obstructive jaundice need to biliary drainage.     

经皮肝穿刺胆管引流联合三维适形放疗治疗肝门部癌伴梗阻性黄疸

目的观察经皮肝穿刺胆管引流（PTCD）联合三维适形放疗（3D-CRT）治疗肝门部癌伴梗阻性黄疸的临床疗效。方法对26例肝门部癌伴梗阻性黄疸患者行经PTCD,胆红素下降后行3D-CRT。结果 26例患者均引流成功,术后胆红素均较术前明显下降（P〈0.05）;行3D-CRT后总有效率73.08%,中位生存期14.5个月。全组无治疗相关的严重并发症。结论 PTCD联合3D-CRT治疗肝门部癌伴梗阻性黄疸近期疗效好,且安全性高。     

药物干预降低恶性梗阻性黄疸行PTCD术后急性胰腺炎40例临床分析

[目的]分析恶性梗阻性黄疸患者行PTCD前后应用药物进行预处理以减少术后急性胰腺炎的发生。[方法]对40例高龄、低位恶性肿瘤所致梗阻性黄疸患者,行DSA引导下VrCD胆道支架植入及肝外引流管植入治疗。分为对照组及药物预处理组,每组20例。对照组术前、术后不行预防性用药：药物预处理组患者术前1h预防性皮下注射醋酸奥曲肽0．1mg,术后继续皮下注射醋酸奥曲肽0．1mg,每8h1次,连续3d。分别于术前、术后24h、48h及72h观察两组患者症状体征,复查血、尿淀粉酶及胰腺CT情况。[结果]72h内药物预处理组与对照组恶心呕吐情况无差异（P〉0．05）;腹痛及腹膜炎情况药物预处理组轻于对照组（P〈0．05）;血淀粉酶升高例数药物预处理组明显多于对照组（P〈0．01）;尿淀粉酶升高例数药物预处理组明显多于对照组（P〈0．05）;术后72h内腹部CT阳性例数药物预处理组6例、对照组1例（P〈0．05）;药物预处理组术后确诊胰腺炎1例,对照组7例（P〈0．05）。[结论]针对高龄、低位恶性梗阻性黄疸患者行PTCD治疗时,可于术前及术后预防性应用醋酸奥曲肽。以减少术后发生急性胰腺炎概率或减轻术后急性胰腺餐病情程摩有利干患者术后恢复．     

Comparison of Infection between Internal-External and External Percutaneous Transhepatic Biliary Drainage in Treating Patients with Malignant Obstructive Jaundice

Purpose: Percutaneous transhepatic biliary drainage (PTBD) is a form of palliative care for patientswith malignant obstructive jaundice. We here compared the infection incidence between internal-externaland external drainage for patients with malignant obstructive jaundice. Methods: Patients with malignantobstructive jaundice without infection before surgery receiving internal-external or external drainage fromJanuary 2008 to July 2014 were recruited. According to percutaneous transhepatic cholangiography (PTC), ifthe guide wire could pass through the occlusion and enter the duodenum, we recommended internal-externaldrainage, and external drainage biliary drainage was set up if the occlusion was not crossed. All patients withinfection after procedure received a cultivation of blood and a bile bacteriological test. Results: Among 110patients with malignant obstructive jaundice, 22 (52.4%) were diagnosed with infection after the procedure inthe internal-external drainage group, whereas 19 (27.9%) patients were so affected in the external drainagegroup, the difference being significant (p<0.05). In 8 patients (36.3%) in the internal-external group infectionwas controlled, as compared to 12 (63.1%) in the external group (p< 0.05). The mortality rate for patients withinfection not controlled in internal-external group in one month was 42.8%, while this rate in external group was28.6% (p< 0.05). Conclusion: External drainage is a good choice, which could significantly reduce the chance ofbiliary infection caused by bacteria, and decrease the mortality rate at one month and improve the long-termprognosis.     

超声引导经皮经肝穿刺胆管置管引流治疗晚期恶性梗阻性黄疸

目的 探讨超声引导经皮经肝穿刺胆管置管引流(percutaneoua transhepatic cholangial drainage,PTCD)治疗晚期恶性梗阻性黄疸的临床应用价值.方法 晚期恶性梗阻性黄疸28例,在B超引导下采用静脉导管施行胆管置管引流.结果 28例1次置管成功率96.43%(27/28),2次置管成功率100%(1/1),引流量360～800 mL/d,1周后血清总胆红素降至85.5～170.1 μmol/L.结论 超声引导经皮经肝穿刺胆管准确性高、灵活、安全、实时.采用静脉导管置管引流安全实用,价格低廉,值得推广.     

PTC与PTBD在恶性梗阻性黄疸诊断治疗上的应用

本文报告对肿瘤性黄疸病人行PTC86例,PTBD30例的临床体会。指出PTC方法简单、成功率高、合并症少。PTBD治疗梗阻黄疸作用分为术前减黄和姑息外引流两方面。尤其是不需X线设备,床旁体表定位下的PTBD17例,15例成功,更为简便、合并症少,对梗阻性黄疸有治疗价值。作者建议,对肿瘤性黄疸病人采用以下诊治步骤:B超→ERCP→床旁PTBD→经管造影,决定治疗方案为进一步手术治疗或永久带管外引流,提供有力依据。     

Percutaneous Transhepatic Biliary Drainage for the Treatment of Obstructive Jaundice Caused by Metastases from Nonbiliary and Nonpancreatic Cancers

The usefulness of percutaneous transhepatic biliary drainage(PTBD) in the treatment of obstructive jaundice caused by metastasesfrom nonbiliary and nonpancreatic cancers was evaluated. Eighteenpatients underwent PTBD during a 3-year period. The primarycancers were located in the stomach (nine cases), colon (four),lung (three), uterus (one), and breast (one). The causes ofobstructive jaundice and bile duct strictures were investigatedusing both abdominal computed tomography and abdominal ultrasonography.The causes of obstructive jaundice, the usefulness of PTBD interms of the relief of symptoms and laboratory data, survivalafter PTBD, and the relationship between patient characteristicsand survival were evaluated. Obstructive jaundice was most oftenattributable to metastases to the lymph nodes (17 of 18 cases).One case was attributed to metastasis to the liver. PTBD decreasedthe jaundice and relieved the symptoms caused by biliary tractobstruction. Median survival after PTBD was 59 days. Patientswhose performance status was 2 or less survived longer thanthose with a performance status of 3 or more (P = 0.018). Furthermore,patients aged less than 60 years tended to survive longer thanthose aged 60 or over (P = 0.057). Our results suggest thatPTBD is useful for relief of symptoms caused by obstructivejaundice in patients with nonbiliary and nonpancreatic cancers.     

恶性梗阻性黄疸的介入治疗

目的 :探讨介入治疗恶性梗阻性黄疸的临床价值。方法 :31例恶性梗阻性黄疸患者先行PTCD( 17例 )及金属支架置入术 ( 14例 ) ,1周后行肝动脉灌注化疗或栓塞治疗。结果 :31例PTCD或胆道内支架置入后 ,血清总胆红素下降。 2例患者 2个月内死于与本治疗无关的原因。 2例支架再狭窄。所有病例均获随访 ,平均生存 9个月 ,最长 2 6个月。结论 :介入治疗恶性梗阻性黄疸是一种有效的方法 ;介入治疗可以延长恶性梗阻性黄疸患者的生存时间。     

经皮肝穿胆道内涵管置入治疗梗阻性黄疸

目的：探讨经皮肝穿胆道内涵管置入治疗梗阻性黄疸的疗效及并发症。方法对５５例梗阻性黄疸患者行经皮肤穿胆道内涵管置入术,其中４５例随访３０至３３２天,观察近中期疗效和并发症。结果：经皮肝穿胆道内涵管置入术技术成功率为１００％,置入后血总胆红素水平较置入前明显下降（Ｐ〈０．０５）。开通时间平均为１０８天,半年开通率为５６％。并发症发生率１６％,主民括胰腺炎和逆行胆道感染等。结论：经皮肝穿胆道内涵管置入术     

122例恶性梗阻性黄疸患者介入引流术后总胆汁酸检测的意义

[目的]观察恶性梗阻性黄疸患者于经皮肝穿刺胆道造影及引流术（PTCD）术后血清总胆汁酸（TBA）、总胆红素（TBL）及直接胆红素（DBL）的变化。[方法]122例恶性梗阻性黄疸患者PTCD术前1d及术后第3d至4周内作TBA、TBL、DBL检测。[结果]PTCD术前TBA（131．8±76．6μmol／L）与TBL（416．0±127．5μLmol／L）、DBL（300．4±86．9μmol／L）有良好相关性（r值：0．358、0．379，P〈0．05）；术后3dTBA下降明显（15．9±22．6μmol／L），与术前（131．8±76．6μmol/L）比较有显著性差异（P〈0．01）。[结论]血TBA可作为检验PTCD术后黄疸引流是否有效的可靠指标。