改良经皮肝穿胆道引流术治疗恶性胆道梗阻

目的探讨改良经皮肝穿胆道引流术（percutaneous transhepatic cholangiodrainage，PTCD）治疗恶性梗阻性黄疸的临床价值。方法107例梗阻性黄疸病人行PTCD术放置胆道引流管或支架：B超导向改良PTCD术40例，X线导向改良PTCD术26例，常规PTCD术41例。观察治疗前后血清胆红素和转氨酶变化，比较三种方法肝脏穿刺次数、穿刺时间和内引流或支架植入例数、引流有效时间。结果治疗前后血清总胆红素和谷丙转氨酶均下降，B超导向改良PTCD术肝脏穿刺次数和穿刺时间短于X线导向改良PTCD术（t=6．2338，P〈0．05；t=32．7243，P〈0．05）和常规PTCD术（t＋7．3598，P〈0．05；t=-34．4050，P〈0．05），内引流或支架植入，改良PTCD术优于常规PTCD术（X^2=61．4960，P〈0．05）。结论改良PTCD术可有效治疗恶性梗阻性黄疸，简单、实用、安全、经济，能明显改善病人的生存质量。

Improved percutuneous transhepatic cholangiodrainage for treatment of malignant obstructive jaundice

Objective To determine the clinical value of improved percutaneous transhepatic cholangiodrainage (PTCD) for malignant obstructive jaundice (MOJ). Methods Of the 107 patients with MOJ, 40 received improved PTCD under ultrasound guidance (group A), 26 improved PTCD under roentgenoscopic guidance (group B) and 41 routine PTCD (group C). The serum levels of bilirubin and transaminase were determined before and after the treatments. The number of hepatic punctures, time of puncturing and internal drainage or metallic stems were separately analyzed for the 3 groups. Results The serum levels of total bilirubin and glutamic-pyruvic transaminase decreased in all the patients after PTCD. The number of hepatic punctures and time of treatment were significantly shorter in group A than in group B and C (P<0. 05), Meanwhile, the number of internal drainage or metallic stents was higher in group A and B than in group C (P<0. 05). Conclusions Improved PTCD is an simple, useful, safe, economic and effective method for treatment of MOJ and it can improve the life quality of the patients.