恶性胆道梗阻PTCD疗效分析与并发症的处理

目的分析经皮经肝穿刺胆道引流（PTCD）对阻塞性黄疸患者的治疗效果,并探讨相关并发症的处理方法。方法58例阻塞性黄疸患者,分为A、B两组,在超声及X线双监视下行PTCD术。A组（n=20）采取套管穿刺技术,B组（n=38）采取一步法Seldinger穿刺技术;27例术后接受经肝动脉化疗栓塞（TACE）或单纯动脉灌注化疗（TAI）术;观察肝功能的改善、并发症的发生,并对并发症做相应的处理;随访并分析生存率。结果PTCD术后1周皮肤瘙痒明显减轻,天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、直接胆红素（DBIL）和碱性磷酸酶（ALP）指标较术前均有明显下降（P均〈0.01）,2周后减黄效果趋于稳定;有发热症状者于1-7 d消失,白细胞升高者1周内显著下降（P均〈0.01）;发生各类并发症共17例次,包括发热、腹痛、出血、胆漏、胆红素血症、引流管或支架阻塞等,A、B组间发生率差异无统计学意义,均获成功处理;PTCD术后接受TACE或TAI者生存率明显高于单纯PTCD者（P〈0.01）。结论PTCD在减轻黄疸、改善肝功能及控制感染方面疗效可靠;并发症的发生率与穿刺方法无关,需积极处理以保证引流;PTCD联合TACE或TAI能显著延长患者生存期。

The efficiency of percutaneous transhepatic cholangio - drainage for malignant biliary obstruction and management of complications

Objective To analyze the efficiency of percutaneous transhepatic cholangio-drainage(PTCD) for malignant biliary obstruction,and to explore the managing methods of complications.Methods Fifty-eight patients with obstructive jaundice were divided into two groups,accepted PTCD.The coaxial cannula technique and the one-step Seldinger technique were performed in group A(n=20) and group B(n=38) respectively,and 27 patients accepted TACE and TAE following PTCD.Observed the improvement of liver function about preoperation,complications and survival rate.Results One week after PTCD,skin pruritus was allevivated obviously,the indices of ALT,AST,TBIL,DBIL,ALP were all less than those of preoperation respectively(all P<0.01).Those patients with fever and higher WBC number(>1000 G/L) were got back.All kinds of postcomplications came to 17 cases,and the difference of occurrence rate between the group A and group B was not significant,bile drainage was assured after management of these complications.The survival rate of those patients accepted TACE or TAI followed PTCD was higher than that of others.Conclusion PTCD is reliable in draining bile,improving liver function and controlling infection.The occurrence of complications is irrelated stab methods,and it's necessary to deal with complications to assure the drainage.PTCD combined TACE or TAI can significantly prolong the survival rate.