PTCD联合胆管支架对恶性梗阻性黄疸姑息性治疗的临床研究

目的研究经皮肝穿刺胆管引流术（PTCD）联合胆道内金属支架置入作为一种姑息性方法对恶性梗阻性黄疸的治疗价值。方法2005年1～12月，行PTCD治疗的恶性梗阻性黄疸患者76例。穿刺肝左叶胆管46例，肝右叶胆管36例，同时穿刺6例。减黄3d后，经引流管行常规胆道造影，30例维持原PTCD外引流，6例改为内外引流，40例置入镍钛形状记忆合金支架并维持PTCD外引流，其中5例行左右肝管双支架同时置入，2例因导丝通过狭窄段困难，于3d后重试，成功置入支架。结果1例因胆道大出血于术后8d死亡，余75例患者治疗后血清总胆红素有39例下降明显，33例呈不同程度的下降，3例仍呈上升趋势。72例患者治疗前后血清总胆红素、直接胆红素差异有统计学意义（P〈0．05）。72例患者在皮肤瘙痒、厌食、皮肤黄疸及尿液颜色方面均较术前有不同程度的改善，3例患者无改善，甚至加重。12例发生术后并发症，发生率为15．8％，有6例发生两种或两种以上并发症。随访至2006年4月，有54例患者死亡，排除因术后严重并发症短期死亡1例，平均生存时间为7．6个月，单纯PTCD患者为5．8个月，联合胆道支架置入患者为9．5个月。结论PTCD联合胆道内金属支架置入作为一种微创介入治疗技术，安全性高，可有效解除恶性胆道梗阻，对于无手术机会且未合并肝细胞性黄疸的恶性梗阻性黄疸患者不失为一种较好的姑息性减黄手段。在生存质量和生存时间两方面，联合胆道支架置入患者均优于单纯PTCD患者。

Clinical investigation on palliative management of malignant obstructive jaundice with PTCD and biliary tract stents

Objective To investigate the clinical value of percutaneous transhepatic cholangiographic drainage(PTCD) and posting of biliary metallic stents on the treatment of malignant obstructive jaundice. Methods From January to December in 2005,76 patients with malignant biliary obstruction were treated by the PTCD guided by ultrasound. A total of 40 biliary tract metallic stents were placed in 3 days after PTCD. Results Plasma bilirubin reduced markedly in 39 patients,partly reduced in 33 patients,increased in 3 patients. Degree of skin pruritis,anorexia,jaundice and colour of urine alleviated in a degree in most patients, otherwise,3 patients became worse(P<0.05). Complications occurred in 12 patients,the incidence rate was 15.8%,two or more complications occurred in 6 patients. Fifty-four patients died before April,2006,average survival time was 7.6 months in 75 patients,the patients of PTCD only were 5.8 months,the patients of combined with biliary stent were 9.5 months. Conclusions PTCD combined with biliary tract stent is a safe and effective method to relieve malignant biliary obstruction,it can improve life quality,prolong survival time,it is a good method to treat the patients with malignant biliary obstruction and without operation. For coming into being intestinal drainage,PTCD combined with biliary tract stent is better than that of PTCD only.