【摘要】 目的观察并比较经皮经肝穿刺胆管内外引流术治疗ERCP难治性恶性胆道梗阻的远期疗效和并发症。方法回顾性分析1999年9月至2005年12月上海长海医院经皮经肝穿刺胆管内外引流术治疗ERCP难治性恶性胆道梗阻患者的资料,比较行胆管金属支架内引流术和导管外引流术术后黄疸消退时间、无黄疸生存期、需再次施行胆管穿刺引流术的例次数和并发症。共67例患者入选,其中,内引流组28例(男18例,女10例),平均年龄(63．4±11．3)岁;外引流组39例(男30例,女9例);平均年龄(61．5±13．2)岁。结果内引流组和外引流组术后黄疸明显消退率分别为85．71％和79．48％(P>0．05);皮肤巩膜黄染平均消退时间为(21．4±18．6)和(34．2±23．6)d(P< 0．05);术后平均无黄疸生存期为(5．4±3．7)和(2．6±2．1)个月(P<0．01);需再次施行胆管穿刺引流术分别为3例次和16例次(P<0．05);内引流组阻塞性黄疸合并胆道感染3例、肠梗阻2例,外引流组导管移位和脱落14例、导管堵塞5例、出血和胆漏各1例,并发症发生率两组差异有统计学意义(P<0．05)。结论经皮经肝穿刺金属支架内引流术较导管外引流术能更显著地缩短ERCP难治性胆管恶性梗阻患者黄疸消退时间、延长无黄疸生存期,减少重复介入次数和并发症。更多还原

【Abstract】 Objective To compare the long-term results of percutaneous transhepatic biliary drainage with external catheters or metallic stents for ERCP refractory malignant biliary obstructions. Methods To review the data of those patients with ERCP refractory malignant biliary obstructions treated with external catheters or metallic stents in Changhai hospital from September, 1999 to December, 2005. Metallic stents were implanted in 28 patients ( 18 men, 10 women, mean age, 63. 4±11. 3 years) , and external catheters were implanted in 39 patients (30 men, 9 women, mean age, 61. 5±13. 2 years). Results The remission rate of jaundice were 85. 71% and 79. 48% in the metallic stents group and the external catheters group respectively (P > 0. 05). The periods of jaundice remission were (21. 4±18. 6) and (34. 2±23. 6) days respectively (P < 0. 05). The jaundice-free life span after the procedures were (5. 4±3. 7) and (2. 6±2. 1) months respectively ( P <0. 01 ). The number of repeated procedures required were 3 and 16 respectively (P < 0.05). Three recurrent biliary obstructions and two duodenal obstructions occurred in the metallic stents group, while 14 catheter migrations, 5 catheter occlusions, 1 bile leakage and 1 bleeding occurred in the external catheters group. The incidence rate of complications in the external catheters group was higher significantly than that in the metallic stents group ( P < 0. 05). Conclusion The long-term results suggest that percutaneous transhepatic biliary drainage with self-expandable metal stents is more rapid for jaundice remission than that with external catheters, and can more effectively extend jaundice-free periods and reduce the number of repeated procedures.更多还原