PTCD诊断、治疗胆道-胃肠道吻合术后梗阻性黄疸的应用价值

目的观察经皮肝穿刺胆道引流（percutaneous transhepatic cholangio-drainage，PTCD）在胆道-胃肠道吻合术后出现梗阻性黄疸患者的应用价值。方法2003年9月-2008年1月。对45例胆道-胃肠道吻合术后出现梗阻性黄疸患者行PTCD治疗。结果45例均成功进行PTCD，其中11例（24．44％）合并胆道感染。PTCD前患者黄疸TBIL（185．89±104．68）μmol／L，DBIL（136．85±84．53）μmol／L，引流4～14天后，患者黄疸情况明显改善，术后TBIL（84．09±63．82）／xmol／L（t=8．72，P〈O．05），DBIL（60．54±51．37）μmol／L（t＝8．15，P〈0．05）。随访2～48个月（平均10．21个月）期间发现胆瘘1例，肝动脉假性动脉瘤1例，未见其他并发症，42例获得二次治疗机会。结论PTCD对胆道胃肠道吻合术后梗阻性黄疸患者的诊断、治疗有较高的临床应用价值。

Clinical application of PTCD in diagnosis and treatment for the patients with obstructive jaundice after Roux-en-Y anastomosis and gastrojejunostomy

Objective To access the clinical application value of percutaneous transhepatic cholangio drainage （PTCD） in the patients with obstructive jaundice after Roux-en-Y anastomosis and gastrojejunostomy. Methods A total of 45 cases （34 males and 11 females, aged 24--76, mean 57.11±12.45]years） with obstructive iaundice after Roux-en-Y anastomosis and gastrojejunostomy were studied retrospectively. Results PTCD was successfully performed in all 45 patients, and infection of biliary tract was proved in 11 （24.44%） patients. No PTCD related complication occurred. The total bilirubin level （TBIL） decreased obviously from （185.89±104.68）μmol/L to （84.09±63.82）μmol/L （t=8.72, P（0.05）, and the direct bilirubin level （DBIL） from （136. 85±84. 53）μmol/L to （60. 54±51.37）μmol/L （t=8.15, P〈0.05）, 4--14 days after PTCD. During the follow up periods of 2--48 （mean 10.21） months, biliary fistula and hepatic artery pseudoaneurysm occurred in 2 patients, respectively, whereas second therapeutic chance became obtained in 42 patients. Conclusion As a safe, effective, minimally invasive and low complication method, PTCD has high clinical application value of the diagnosis and treatment for the patients with obstructive jaundice after Roux-en-Y anastomosis and gastrojejunostomy.