经皮肝穿刺不同胆道引流术治疗恶性阻塞性黄疸效果比较

目的评价经皮经肝穿刺胆道引流术(PTCD)在恶性阻塞性黄疸(MBOJ)患者中的临床应用价值。方法回顾性分析1995-03～2009-07收治的118例恶性阻塞性黄疸患者的临床资料。按照不同方式分为三组。A组:经X线引导下经皮肝穿刺胆道置管引流术(xPTCD)放置可膨胀性胆道金属内支架(EMS)组27例。B组:超声引导下经皮肝穿刺胆道置管引流术(uPTCD)组75例。C组:xPTCD、uPTCD及ERCP下行胆道塑料内支架引流术(ERBD)或胆道金属支架置入内引流术(EMBE)组16例。结果三组之间的疗效及术后生存率等方面无显著差异(P>0.05),但A组及C组术后并发症的发生率明显增高(P<0.01)。结论 PTCD、ERBD/EMBE是手术不能根治的MBOJ较为有效的姑息性治疗方法,uPTCD法并发症较少,在实时、方便、经济、易防护等方面更具优势。

Clinical efficacy of percutaneous transhepatic cholangiography drainage on malignant biliary obstructive jaundice: Comparative study of different procedures

Objective To evaluate the clinical application value of percutaneous transhepatic biliary drainage (PTCD) in patients with malignant biliary obstructive jaundice (MBOJ). Method The 118 cases of MBOJ were divided into the following three groups. In group A, 27 cases of MBOJ were placed expandable metal biliary stents (EMS) by X-rays positioning after PTCD(xPTCD). PTCD drainages by ultrasound-guided were operated in 75 patients with malignant obstructive jaundice in group B(uPTCD). In group C (PTCD+ ERBD/EMBE), the 16 cases of MBOJ were operated in percutaneous transhepatic biliary drainages by xPTCD, uPTCD or ERCP, and placed endoscopic retrograde biliary drainage (ERBD)or endoscopic metal biliary endoprothesis(EMBE). Result There was no significant difference (P >0.05) among A, B, and C groups in curative effect and survival rates. But the incidence rate of postoperative infection was significantly decreased in group B (P<0.01). Conclusion PTCD and ERBD/EMBE are the effective palliative treatment in patients with MBOJ. uPTCD has a fewer incidence rate of postoperative infection, and has excellent advantages such as in the real-time, convenience, security and so on.