高龄患者恶性梗阻性黄疸介入治疗（附32例临床分析）

目的：探讨支架置入治疗高龄恶性梗阻性黄疸的临床疗效。方法：将32例70岁以上的恶性梗阻性黄疸患者行经皮经肝穿刺、胆道造影确定狭窄部位,若导丝能通过狭窄段则一次置入支架,若导丝不能通过则置入外引流管,外引流7～10 d后再置入支架。其中24例支架一次性放置成功,4例经外引流10 d后再放置获得成功,全部患者均同时留置外引流管。结果：本组患者术前的总胆红素、谷丙转氨酶、碱性磷酸酶分别为（372.3±128.4）μmol/L、（118.9±67.2）U/L、（754.2±332.4）U/L;术后1 w降至（159.9±117.3）μmol/L、（82.4±37.3）U/L、（436.7±241.2）U/L,与术前比较其差异有统计学意义（P〈0.05）;术后2 w为（107.8±48.1）μmol/L、（52.0±23.7）U/L、（231.1±104.3）U/L,与术前比较其差异亦有统计学意义（P〈0.01）。临床改善3例,术后明显好转26例,总有效率为90.6%。随访3个月,30例黄疸完全消退,2例明显减轻;随访半年时死亡5例。结论：胆道支架植入术治疗恶性梗阻性黄疸疗效确切、安全性高,能提高患者的生活质量。

The clinical application of stent placement in the therapy of malignant biliary obstruction of elderly patients: a report of 32 cases

Objective： To explore the clinical curative effects of stent placement to the therapy of malignant biliary obstruction in elderly patients.Methods： For 32 patients with malignant biliary obstruction and more than 70 years old perform PTC to localize stenosis.If guide wire can pass stenosis location,put stent inside.If not,put external drainage tube.After 7～10 days,place stent.For 24 patients,stents were successfully placed once in a time.For 4 patients,10 days after external drainage tube,stents were successfully placed.All patients were put external drainage tube.Results： Before operation,total bilirubin,GPT and alkaline phosphatase were（372.3±128.4） μmol/L,（118.9±67.2）U/L and（754.2±332.4）U/L respectively.One week after operation,they were reduced to（159.9±117.3）μmol/L,（82.4±37.3）U/L and（436.7±241.2）U/L.Two weeks after operation,they were（107.8±48.1） μmol/L,（52.0±23.7）U/L and（231.1±104.3）U/L respectively.Compared with before operation,P〈0.05 and P〈0.01 respectively.Three cases showed clinical improvement and 26 cases showed significant improvement after operation.The total effective rate was 90.6%.After 3 months＇ follow-up,jaundice completely disappeared in 30 cases and 2 cases showed significant relief;after half a year＇s follow-up,5 patients died.Conclusion： Using biliary tract stent implantation to treat malignant biliary obstruction can get precise curative effect and high safety,and can promote life quality.