经皮肝穿胆道内外引流治疗恶性梗阻性黄疸

目的 评价经皮肝穿胆道内外引流术（PTBIED）治疗恶性梗阻性黄疸的临床价值。方法 对43例恶性梗阻性黄疸患者，进行了PTBIED治疗，其中肝门部转移癌14例，胆囊癌8例，胆管癌8例，胰头癌13例。结果 PTBIED成功率为90%，40例血清总胆红素降至正常，3例下降不满意，术后1个月内死亡4例，6个月内死亡20例，生存超过12个月13例。并发症为胆道活动性出血8例（18.6%)，败血症10例（23.3%)，胆道逆行感染6例（14.0%)。胆汁性腹膜炎1例（2.3%)。结论 PTBIED是姑息性治疗手术不能切除的恶性梗阻性黄疸有效的和安全的方法。

Effect of pecutaneous transhepatic biliary internal external drainage in treatment of malignant biliary obstruction

Objective To evaluate the clinical value of percutaneous transchepatic biliary internal external drainage (PTBIED) in treatment of malignant biliary obstruction.Methods Forty-three patients with malignant biliary obstruction,including 14 cases with hilary metastasis cancer 8 with carcinoma of gallbladder,8 with hilary biliary cancer,13 with pancreatic cancer were treated with PTBIED.Results The technical success rate was 90%.The serum total bilirubin almost fell to normal level in 40 patients.Four cases (9.3%) died within 1 month, twenty (46.5%) cases died within 6 months,thirteen (30.2%) cases are still alive 12 months later.The complications cases mild hemobilia (8 cases,18.6%),bacteriemia(10 cases,23.3%),retrograde infection(6 included,14.0%).Conclusion PTBIED is an effective and safe therapeutic method for palliation of malignant biliary obstruction.