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目的探讨梗阻性黄疸经皮肝穿刺胆道支架置入及引流术的治疗方法与疗效。方法对44例胆道梗阻患者先行经皮肝穿刺胆道造影(PTC),如导丝不能越过阻塞段,则直接行外引流;如能越过阻塞段,则行支架置入或内外引流术。结果44例患者中6例单纯外引流;7例单纯内外引流;2例仅行PTC胆道造影而未行胆道引流;29例置入支架32枚,其中19例行支架置入+外引流,10例单纯支架置入。在有完整随访资料的16例中,术后1周血清总胆红素从术前(351±142.4)μmol/L降至(143.5±97.6)μmol/L,13例血清总胆红素1个月降到正常或接近正常水平,3例血清总胆红素1个月无明显下降(<50%)。死亡9例,生存时间3～21个月,中位生存期6.8个月。结论经皮肝穿刺胆道支架置入及引流术是治疗梗阻性黄疸的一种安全、有效的姑息性方法。
Objective To investigate the treatment and efficacy of percutaneous transhepatic biliary stent implantation and drainage in obstructive jaundice. Methods Percutaneous transhepatic cholangiography (PTC) was performed in 44 patients with biliary obstruction. If the guide wire can not cross the obstruction, the external drainage was performed directly. If it could cross the obstruction, the stent was inserted or internally and externally drained. Results Of the 44 patients, 6 cases were treated with extradural drainage alone, 7 cases with simple internal and external drainage, 2 cases with PTC cholangiography without biliary drainage, 29 cases with stent placement, of which 19 cases were treated with stent placement plus external drainage and 10 Case simple stent placement. In the 16 patients with complete follow-up data, serum total bilirubin decreased from (351 ± 142.4) μmol / L to (143.5 ± 97.6) μmol / L at 1 week after surgery, and 1 serum total bilirubin Month to normal or near normal levels, 3 cases of serum total bilirubin 1 month no significant decline (<50%). 9 died, the survival time was 3 to 21 months, and the median survival time was 6.8 months. Conclusion percutaneous transhepatic biliary stent implantation and drainage is a safe and effective palliative treatment of obstructive jaundice.