PTCD在高龄恶性梗阻性黄疸患者治疗中的临床应用

目的评价透皮经肝胆造影及引流术（PTCD）对高龄恶性梗阻性黄疸患者的治疗效果。方法63例经CT，MRI和超声或活检证实的恶性梗阻性黄疸患者（男性34例，女性29例，年龄68～96岁，平均78.5岁），其中，胆管癌20例，胆囊癌8例，肝癌8例，肝转移瘤10例，以及胰头癌17例，均接受了PTCD，19例又经胆道内支架植入。对全部患者的临床资料进行了回顾性分析。结果PTCD在所有患者中获得了技术成功。介入治疗后，患者的主要症状与体征，诸如黄疸、发热、皮肤瘙痒等均得到有效控制和明显缓解，血清总胆红素（STB）与谷丙转氨酶（ALT）水平均较治疗前显著降低。本组患者中PTCD引起的并发症有胆道少量出血，发热，肝区疼痛等，但这些症状经对症治疗后很快消失，未发生与该治疗操作有关的严重并发症。结论PTCD是姑息性治疗高龄恶性梗阻性黄疸患者的一种安全、有效方法。

Efficacy of PTCD for treating malignant obstructive jaundice in senile patients

Objective To evaluate the efficacy of percutaneous transhepatic cholangiography and drainage（PTCD）for treating malignant obstructive jaundice （MOJ）in senile patients.Methods Sixty-three patients （34 mm,29 women; aged 68-96 years; mean age,78.5 years）with MOJ confirmed by CT,MRI, US or biopsy,which comprised cholangiocareinoma（n=20）,gallbladder earcinoma（n=8）,hepatic carci- noma （n=8）,hepatic metastasis （n=10）,and pancreatic head carcinoma （n=lT）underwent PTCD.19 patients underwent additional bile duct stent implantation.The clinical data in all patients were retrospectively analyzed.Results PTCD was technically successful in all patients. The main symptoms and signs such as jaundice,fever and skin pruritus etc in all patients were controlled effectively or relieved markedly while the levels of serum total bilirubin（STB）and alanine transaminase（ALT）were significantly decreased in comparison with those before the treatment.The complications from PTCD in the group patients were found to be litter biliary hemorrhage,fever and hepatic region pain but these symptoms were quickly disappeared after heteropathy and there were no severe complications related to the procedure,Conclu- sion PTCD is a safe and effective modality for conservatively treating MOJ in senile patients.