经皮肝穿刺胆道引流联合支架植入治疗恶性阻塞性黄疸

目的:评估经皮肝穿刺胆道引流联合支架植入治疗恶性阻塞性黄疸的安全性和临床疗效。方法:回顾性分析30例经皮肝穿刺胆道引流联合支架植入治疗的恶性阻塞性黄疸,评价其手术成功率、临床疗效、并发症发生率。结果:技术成功率100%,患者梗阻性黄疸症状明显解除。血清总胆红素[术前vs术后为(233.6±109.1)vs(110.2±73.9)μmol/L,t=7.681,P<0.001);直接胆红素[术前vs术后为(192.0±96.0)vs(81.7±54.4)μmol/L,t=7.287,P<0.001];丙氨酸氨基转移酶[术前vs术后为(117.2±67.7)vs(41.8±20.7)U/L,t=6.614,P<0.001]水平明显降低,患者全身状况明显改善。5例术后胆道出血,其中1例血栓阻塞胆道支架;10例高淀粉酶血症,其中轻症急性胰腺炎1例;胆道感染5例;支架阻塞6例;未发生其他严重并发症。结论:经皮肝穿刺胆道引流联合支架植入操作安全,疗效明显,是一种治疗恶性阻塞性黄疸的理想方法。

Percutaneous transhepatic cholangial drainage combined with stent implantation in the treatment of malignant obstructive jaundice

Objective: To evaluate the technical feasibility and efficiency of percutaneous transhepatic cholangial drainage(PTCD) combined with stent implantation in the treatment of malignant obstructive jaundice.Methods: 30 patients with malignant obstructive jaundice were underwent the treatment of PTCD combined with stent implantation the outcomes were evaluated retrospectively in term of technical successful rate,efficiency and complications.Results: The technical successful rate was 100%.The symptoms and signs of obstructive jaundice were relieved rapidly and the performance status were improved in most patients.The levels of serum total bilirubin(233.6±109.1) μmol//L vs(110.2±73.9) μmol//L(t=7.681,P<0.001),direct bilirubin [(192.0±96.0) μmol/L vs(81.7±54.4) μmol/L,t=7.287,P<0.001],and alanine aminotransferase [(117.2±67.7) U/L vs(41.8±20.7) U/L,t=6.614,P<0.001] decreased significantly between the pre-operation and post-operation,respectively.Hemobilia,stent blockage by thrombosis,hyperamylasemia,and mild pancreatitis,biliary tract infection,stent blockage were observed in 5,1,10,15,and 6 patient(s) respectively.No severe complications were observed.Conclusion: PTCD combined with stent implantation is a safe and effective method in treating malignant obstructive jaundice.