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目的评估不同类型高位恶性胆道梗阻介入治疗的方法及价值。资料与方法高位恶性胆道梗阻44例,按Bismuth-Corlette分型:Ⅰ型9例,Ⅱ型13例,Ⅲa型8例,Ⅲb型1例,Ⅳ型13例。在X线透视下以不同方式行胆道引流或支架置入。以术后4周直接胆红素降至正常或下降超过50%为有效作为近期疗效评价标准,并进行随访。结果Ⅰ型、Ⅱ型、Ⅲa型、Ⅳ型有效分别为9例、8例、5例和8例,1例Ⅲb型无效。随访4周～17个月,失访5例。15例完全无黄疸生存;3例复发黄疸;7例有效但持续轻度黄疸生存;3例有效后黄疸再次加深;11例无效。生存时间:≤3个月14例;>3个月≤6个月13例;>6个月<1年8例;≥1年4例。结论经皮肝穿刺引流或内支架治疗仍是治疗高位胆道梗阻的有效姑息方法,有效减黄是提高患者生存的重要因素。
Objective To evaluate the method and value of interventional treatment of different types of high malignant biliary obstruction. Materials and Methods 44 patients with malignant biliary obstruction were classified as Bismuth-Corlette. There were 9 cases of type I, 13 cases of type II, 8 cases of type IIIa, 1 case of type IIIb and 13 cases of type IV. Biliary drainage or stent placement was performed differently in X-ray. To 4 weeks after the direct bilirubin to normal or down more than 50% effective as a short-term efficacy evaluation criteria, and follow-up. Results The effective rates of type Ⅰ, type Ⅱ, type Ⅲa and type Ⅳ were 9, 8, 5 and 8, respectively. One type Ⅲb was invalid. Follow-up 4 weeks to 17 months, lost to 5 cases. 15 cases were completely free of jaundice; 3 cases had recurrent jaundice; 7 cases were effective but sustained mild jaundice; 3 cases were effective and jaundice deepened again; 11 cases were ineffective. Survival time: ≤3 months in 14 cases;> 3 months ≤6 months in 13 cases;> 6 months <1 year in 8 cases; ≥ 1 year in 4 cases. Conclusion percutaneous transhepatic drainage or stent treatment is still an effective palliative treatment of high biliary obstruction, effective reduction of yellow is an important factor to improve patient survival.