【摘要】 目的探讨经皮肝穿刺胆管-胃引流(PTCGD)治疗顽固性胆道梗阻黄疸的可行性、安全性和有效性。方法健康杂种家猪20只,行胆总管结扎,建立梗阻性黄疸动物模型。动物于术后14d随机分成两组:①PTCGD组(A组,n=10):行PTCGD,置入内引流管。②对照组(B组,n=10):在胆总管结扎后不予治疗。两组在不同时间段内观察血清总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸转氨酶(ALT),白蛋白(ALB)变化,比较2组间及内引流前后差异,观察肝脏病理学和影像学改变。结果A组技术成功率为100%,行PTCGD后肝内胆管扩张明显减轻,肝功能显著改善,病理表现显示肝组织明显修复好转。B组动物分别死于胆总管结扎术后23～32d,TBIL、DBIL、ALT在胆总管结扎后持续升高,并且随梗阻时间延长逐步加重,胆管造影显示肝内外胆管重度扩张,病理显示肝小叶出现大片状坏死,小叶间胆管胆汁淤滞,扩张明显,肝细胞崩解。结论PTCGD是梗阻性黄疸动物模型,特别是常规介入放射学技术不能成功的顽固性胆道梗阻又一较为安全、有效、微创的治疗方法。更多还原

【Abstract】 Objective To evaluate the feasibility,safety and efficacy of percutaneous transhepatic cholangio-gastric drainage(PTCGD) for the management of obstructive jaundice,especially,for the refractory cases.Methods The ligations of common bile ducts were performed in 20 healthy pigs,including 9 males and 11 females.They were randomly divided into two groups after 14 days of ligation.Group A( n = 10) underwent PTCGD,and Group B(n = 10) served as control group(without management).Liver function,including TBIL,DBIL,ALT and ALB in plasma;and furthermore with CT of liver were carried out in different period for comparison between the 2 groups consisting those before and after the ligation.The changes were demonstrated on CT and the pathology was investigated through hematoxylin and eosin stain under microscopy.Results The technical success rate reached 100% in Group A,with complications occurred mainly of biliary hemobilia and fever.TBIL,DBIL and ALT continuously increased after the ligation but obviously decreased after PTCGD,with rebuilt of the damaged liver tissue.On the contrary,all animals in Group B died on the 23 rd to 32nd day after the ligation of common bile duct.The mean survival time was 28.3 days.TBIL,DBIL and ALT continuously increased from ligation until death.The intra-and extra-hepatic ducts were obviously dilated on the cholangiograms.Severe necrosis of hepatic cells and bile stasis of infra-lobule biliary ducts appeared under microscopy.Conclusions PTCGD is a safe,microinvasive and effective palliative therapy for biliary obstruction,especially the refractory cases in the experimental animals.(J Intervent Radiol,2007,16:269-272)更多还原