论文部分内容阅读
目的：回顾性分析介入性经皮肝穿刺胆道内支架置入术治疗恶性梗阻性黄疸的技术与疗效。方法：对２９例患者采用经皮肝穿刺胆道内支架置入术治疗恶性梗阻性黄疸。胆道梗阻部位位于胆总管９例、肝总管１１例，左右肝管汇合部９例。结果：２９例共置入金属内支架３６枚，其中７例置入２枚。术后１周复查血清生化指标，总胆红素（ＴＢＩＬ）从术前的（４８３．７±１９１．８）μｍｏｌ／Ｌ降至（２２１．３±１３１．７）μｍｏｌ／Ｌ（Ｐ＜０．００１），碱性磷酸酶与丙氨酸转氨酶均下降明显（Ｐ均＜０．００１）。３例于术后１个月内死亡，均与胆道引流无直接因果关系。术后１个月，３项血清生化指标均有更为显著的下降。跟踪随访２３例，平均随访６．０个月，８例仍存活。随访期内１４例（６０．９％）ＴＢＩＬ降至正常范围；８例（３４．８％）ＴＢＩＬ下降至术前的半数以下。结论：经皮肝穿刺胆道金属内支架置入术是对恶性梗阻性黄疸的一种安全、有效的姑息性治疗方法，可明显缓解黄疸，改善肝脏功能，提高生存质量，并可有限地延长生存时间。
Objective: To retrospectively analyze the technique and efficacy of interventional percutaneous transhepatic biliary stent implantation in the treatment of malignant obstructive jaundice. Methods: Percutaneous transhepatic biliary stent implantation was used in 29 patients with malignant obstructive jaundice. Biliary obstruction in the common bile duct in 9 cases, 11 cases of hepatic duct, left and right hepatic duct junction in 9 cases. Results: Twenty-nine patients had a total of 36 metal stents, of which 7 were placed in two. Serum biochemical parameters were reviewed one week after operation, and the total bilirubin (TBIL) was decreased from (483.7 ± 191.8) μmol / L to (221.3 ± 131.7) μmol / L preoperatively .001), alkaline phosphatase and alanine aminotransferase decreased significantly (P <0.001). Three patients died within 1 month after operation and had no direct causal relationship with biliary drainage. One month after operation, the three serum biochemical indexes showed a more significant decrease. Follow up of 23 cases, with an average follow-up of 6.0 months, 8 patients still survived. During the follow-up period, TBIL dropped to the normal range in 14 patients (60.9%); and TBIL in 8 patients (34.8%) decreased to less than half of the preoperative value. Conclusion: Percutaneous transhepatic biliary metal stenting is a safe and effective palliative treatment for malignant obstructive jaundice, which can relieve jaundice, improve liver function, improve the quality of life and prolong the survival time to a limited extent time.