经皮经肝胆管穿刺引流术与胆管支架置入术治疗恶性梗阻性黄疸的疗效评价

目的：探讨经皮经肝胆管穿刺引流术与胆管支架置入术对恶性梗阻性黄疸的临床疗效。方法：回顾性分析2007年9月～2010年8月我院收治的48例恶性梗阻性黄疸患者的临床资料，行经皮经肝胆管穿刺后置入引流管行胆管引流（外引流组）或置入胆管内支架（内引流组）治疗，比较两种治疗方式的近期疗效、肝功能、血常规、术后并发症和生存时间的差异。结果：内引流组治疗近期显效率高于外引流组，差异有统计学意义（P〈0．05）。肝功能指标与术前相比，两组患者术后血清总胆红素（Tbil）、直接胆红素（Dbil）、总胆汁酸（TBA）、碱性磷酸酶（AKP）和谷氨酰转肽酶（GGT）均明显降低，差异均有统计学意义（P均〈0．05），而内引流组术后Tbil、Dbil、AKP和GGT的降低幅度大于外引流组，差异有统计学意义（P均〈0．05）。术后1个月两组血清白蛋白均无明显变化，手术前后差异无统计学意义（P〉0．05）；术后1个月白细胞总数及分类较术前均有下降，但多数未达到正常水平，两组差异有统计学意义（P〈0．05）。两组并发症发生率差异无统计学意义（P〉0．05）。内引流组生存时间超过12个月的患者比例大于外引流组，差异有统计学意义（P〈0．05）。结论：经皮经肝胆管穿刺引流术与胆管支架置入术治疗恶性梗阻性黄疸均安全、有效，而后者较前者引流效果更快速显著。

Effect of percutaneous transhepafic biliary drainage with external catheters and endoscopic metallic stentin on malignant obstructive jaundice

Objective. To observe the therapeutic effect of percutaneous transhepafic biliary drain- age with external catheters and endoscopic metallic stent on malignant obstructive jaundice. Methods. Clin- ical data of 48 cases with malignant obstructive jaundice admitted from Sept 2007 to Aug 2010 were ana- lyzed retrospectively. They were treated with external catheters （external drainage group） or endoscopic metallic stentin （internal drainage group）. The efficacy, adverse effect and survival time were compared. Results： The recent efficiency of the internal drainage group was significantly better than that in the external drainage group （P〈0.05）. Mean serum total bilirubin , direct bilirubin , total bile acid, alkline phos- phatase and glutamyltranspeptidase after the treatment in the two groups was significantly decreased （P〈 0.05）, but the decrease was significantly greater in the internal drainage group than that in the external drainage group （P〈0. 05）. There was no statistically significant difference between the two groups in complication rates and serum albumin （P〈0.05）. After 1 month, the decreased white blood cells were im- proved which was more obvious in the internal drainage group （P〈0.05）, but most still couldn＇t reach normal levels. Number of patients with survival time longer than 12 months in the internal drainage group was statistically higher that in the external drainage group （P〈0.05）. Conclusions. Percutaneous tran- shepafic biliary drainage with external catheters and endoscopic metallic stentin were reliable and safety in treating malignant obstructive jaundice, and the latter method is more rapid and effective.