恶性胆管梗阻经PTC／ERC放置支架的策略和应用

目的分析经PTC／ERC途径放置胆管支架的优势，制定放置支架的策略。方法本组经PTC放置支架68例和经ERC放置支架51例资料，总结两种途径的优越性。结果经PTC和ERC途径放置支架成功率分别为100％和96％，两组无明显出血、漏胆等并发症，生存时间相似。结论时失去手术时机和不能耐受手术的恶性胆管梗阻采取支架置入是有效解除梗阻，提高生存时间和质量的最佳办法，位于胆总管下端和壶腹部的梗阻首选以ERC途径放置支架，位于肝门部及以上的梗阻以PTC途径放置支架为宜。

The applies and strategy of biliary stent placing by percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography for malignant obstruction of biliary tract

Objective To analyse superiority of biliary stent placing for malignant obstruction of biliary tract by percutaneous transhepatic cholangiography （PTC） and endoscopic retrograde cholangiography （ERC）, and to formulate the strategy of biliary stem placing. Methods The clinical data of 68 patients with malignant obstruction of biliary tract who placed biliary stem by PTC and 51 cases by ERC were selected as the object of this study. The placing methods were chosen according to the location of obstruction. A retrospective analysis was done, and the superiority of placing methods were compared, on therapy conditions and effects of ERBD and antituberculosis drugs treatments. Results The achievement ratio of stent placing by PTC was 100%, and which by ERC was 96%. The complication（ bleeding, bile leak） didn＇t happen between two groups, and live time was similar. Conclusion The biliary stent placing is a safe and effective method to the malignant obstruction of biliary tract patients who can be treated by operation. It can relieve biliary obstruction efficiency, and can increase live time and life quality. We can choose the stent placing method by ERC to the cases whose obstruction is at the inferior of common bile duct or duodenal ampulla, arid the cases whose obstr~ction is at the above of porta hepatic should be chosen by PTC.