老年恶性梗阻性黄疸的介入治疗.docVIP

老年恶性梗阻性黄疸的介入治疗 【摘要】 目的：探讨老年恶性梗阻性黄疸行ERCP或PTBD的临床应用价值。方法：83例恶性梗阻性黄疸患者，男性69例，女性14例，年龄59岁～85岁。其中胆管癌18例，胰头癌48例，肝癌7例, 转移癌（胃癌）10 例。所有病例经临床、病理和影像学检查诊断为恶性梗阻性黄疸，且失去手术机会。43例行ERCP，40例行PTBD。结果：ERCP内引流成功38例，所有PTBD术全部引流成功，引流术后两周血清胆红素水平明显较治疗前下降。生存时间最短26 d，最长16个月。结论：ERCP或PTBD对晚期恶性梗阻性黄疸患者是一种良好的降低黄疸的姑息性治疗方法。 【关键词】 黄疸 梗阻性 介入放射学 治疗 　　Interventional Therapy for Malignant Obstructive Jaundice in Elderly Patients 　　ZHOU Liang ,FAN Zhining，TANG Jilai,FENG Yuming 　　The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, China Abstract： Objective To study the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage ( PTBD) for elderly patients with malignant obstructive jaundice. Methods 83 patients with malignant obstructive laundice were palliated by means of drainage with ERCP and PTBD. Eighteen had cholangiocarcinoma, 48 pancrentic carcinoma,7 primary hepatocellular carcinoma, 10 metastatic caicinoma from carcinoma of stomach. The had US. CT. and (or) MRCP and routine serum laboratory data. 43 had ERCP .40 had PTBD including external drainage and internal-external drainage. All patients were followed for a month with clinical evaluation and laboratory examination. Results 43 patients received ERCP, stent placement was conducted in 28 patients.10 patients received plastic catheters. PTBD were successfully performed in all the patients. 21 had PTBD including external drainage and internal-external drainage. The other 19 patients received stents. The levels of serum total bilirubin(TB) decreased significantly after the procedure. Conclusion ERCP or PTBD is safe , effective for malignant biliary obstruction. Key words: Jaundice; Obstructive; Interventional radiography; Therapy 老年阻塞性黄疸在临床上比较常见，这些患者由于脏器机能处于减退状态，免疫力反应性差，且并发症多，因而增加了对疾病诊断及治疗的复杂性。自2005年7月至2007年2月我们共收治阻塞性黄疸患者83例，经内窥镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography ERCP）或经皮肝穿胆管造影(percu