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目的:探讨介入治疗恶性梗阻性黄疸的疗效及影响因素。方法:38例恶性梗阻性黄疸患者,胆管癌术后复发11例,胃癌术后转移8例,胰头癌9例,乳腺癌术后转移2例,肝癌8例,采用经皮肝穿刺胆管造影引流(PTCD)术(21例),裸金属内支架置入术(17例),2周后区域动脉灌注化疗或栓塞治疗37例,9例胰头癌患者结合聚焦超声放疗。结果:38例患者经皮肝穿技术成功率100%,PTCD或内支架置入2周后,血清总胆红素明显下降[(395.6±278.0)limol/Lvs(52.4±60.56)wmol/L,P<0.01)],肝功能明显改善。1例胃癌术后患者两天内死于内出血,其他37例患者均获得随访,平均生存9个月,最长21个月。0.5a内,17枚支架中4例出现阻塞,25条(4例患者放置2根)引流管中因脱出或不通畅更换5条。结论:介入治疗恶性梗阻性黄疸是一种有效延长患者生存时间、减轻痛苦的姑息手段,引流通畅是保证疗效的关键。
Objective: To investigate the efficacy and influencing factors of interventional treatment of malignant obstructive jaundice. Methods: Thirty-eight patients with malignant obstructive jaundice, 11 cases of recurrence of cholangiocarcinoma, 8 cases of postoperative metastasis of gastric cancer, 9 cases of pancreatic head cancer, 2 cases of postoperative metastasis of breast cancer and 8 cases of liver cancer. Percutaneous transhepatic cholangiography PTCD (21 cases), bare metal stent implantation (17 cases), regional arterial infusion chemotherapy or embolization in 37 cases 2 weeks later, and 9 cases of pancreatic cancer combined with focused ultrasound radiotherapy. Results: The success rate of percutaneous transhepatic penetrating technique was 100% in 38 patients. The serum total bilirubin was significantly decreased after treated with PTCD or stent ([(395.6 ± 278.0) limol / Lvs (52.4 ± 60.56) wmol / L, P <0.01)], liver function improved significantly. One patient with postoperative gastric cancer died of internal bleeding within two days. The other 37 patients were followed up for an average of 9 months and a maximum of 21 months. In 0.5a, occlusion was found in 4 of the 17 stents and in 25 of the 4 stents (2 in 4 patients) due to prolapse or unobstructed replacement of 5. Conclusion: Interventional treatment of malignant obstructive jaundice is a palliative means to effectively prolong the survival time and relieve the pain of patients. Draining the patency is the key to ensure curative effect.