经皮经肝穿刺介入治疗恶性梗阻性黄疸261例并发症分析与处理

目的:探讨经皮经肝穿刺胆管引流(PTCD)及胆道支架置入术,治疗恶性梗阻性黄疸并发症发生的原因和处理措施。方法:恶性梗阻性黄疸261例,其中166例行PTCD,91例行胆道支架置入术,4例未完成手术。分析术后2月内并发症发生情况。结果:发生并发症68例,发生率26.05%。胆道感染21例,胆道出血13例,引流管脱出、阻塞11例,胆瘘7例,胆心反射5例,急性胰腺炎5例,支架再狭窄3例,胆汁性胸膜炎1例,肝脓肿1例,死亡1例。除死亡病例外,其余患者经过积极处理,病情好转平稳。介入治疗后黄疸明显减轻。结论:PTCD及胆道内支架置入术是治疗恶性梗阻性黄疸的有效方法,严重并发症发生率低,正确的手术操作及合理的围手术期处理对降低并发生的发生极为重要。

Complications of 261 cases after percutaneous transhepatic puncture for the interventional therapy of malignant obstructive jaundice and the following treatments

Objective:To analyze the causes of the complications of interventional treatment of malignant obstructive jaundice by percutaneous transhepatic cholangial drainage(PTCD)and biliary stent implantation,and summarize the preventions and treatments of complications.Methods:261 cases of malignant obstructive jaundice in our hospital were enrolled in the research.They received PTCD or biliary stenting placement and had complete clinical data.166 cases of them received PTCD and 91 cases received biliary stent placement.The other 4 patients did not complete the operation.The complications within 2 months after the performances were analyzed.Results:68 cases had complications with the incidence of 26.05%.Among them,21 cases were found with biliary tract infections,13 cases with biliary tract bleeding,11 cases with the drainage tube prolapse or obstruction,7 cases with biliary fistula,5 cases with bile-cardiac reflex,5 cases with acute pancreatitis,3 cases with stent restenosis,1 case with bile pleuritis,1 case with liver abscess,and 1 case died.The patients recovered after being treatment properly with the exception of the dead patient.After interventional treatments,patients'jaundice were significantly reduced.Conclusions:PTCD and biliary stenting placement are effective methods for the treatment of malignant obstructive jaundice,with a low occurrence of serious complications.The proper interventional operations and reasonable perioperative handlings are extremely important to reduce the complications.