恶性梗阻性PTCD术后并发症63例临床分析.DOC

PTBD并金属支架置入姑息性治疗恶性高位胆道梗阻（附68例报道） 查勇 寸英丽 黄云超 黄明 马春笋 陈真陈训如关键词 高位胆道梗阻；PTBD; 胆道恶性肿瘤；经皮胆道支架置入 中图分类号： R 657.4 文献标识码： A Percutaneous metallic stents in the palliative management of Patients with malignant biliary obstruction：a study of 68 cases.ZHA Yong1, CUN Ying-li1, Huang Yun-chao1, HUANG Ming1, MA Chun-sun1, CHEN Zhen1, CHEN Xun-ru2 .（1Department of Abdominal Surgery, The third affiliated hospital of kunming medical college, Kunming 650118；2Kunming General Hospital, Kunming 650032，China） Abstract：Object To evaluate the technical success and clinical efficacy of percutaneously placed self-expandable metallic stents in patients with obstructive jaundice. Methods During a 3-year period, Sixty-eight patients with inoperable malignant biliary obstruction were treated with self-expandable metallic stents. The causes of obstructions were hilar cholangiocarcinoma (n=21), hepatocellular carcinoma (n=12), gallbladder carcinoma (n=26), metastatic pancreatic carcinoma (n=6), metastatic gastric carcinoma(n=3). We evaluated the technical success, clinical success, complications, and duration of stent patency. Results：Technical success was achieved in 63 patients(92.6%). Clinical success was achieved in 51 of the 68 patients (75%). Major complications included hemobilia ( n＝2), bile leakage( n＝5), cholangitis( n＝3). which were all treated conservatively. The median survival period was 216 days(range, 28–304 days). The overall mean stent patency was 204 days (range, 60–304 days). Conclusion： Percutaneous metallic stent placement is a feasible and effective palliative treatment for patients with obstructive jaundice. Key Words：Proximal bile duct obstruction; PTBD; Bile duct malignancy; Percutaneous biliary stenting 恶性梗阻性黄疸多见于肝门胆管癌、胰腺癌和胆囊癌等疾病，就诊时患者多处于疾病的晚期而失去了手术的机会，或难以承受传统开腹引流手术带来的创伤。微创的胆道内外引流术在恶性梗阻性黄疸的处理中有着重要的应用价值。现院200年1月至200年1月间恶性梗阻性黄疸percutaneous biliary drainage, PTBD)并胆道金属支架置入68例，分析其并发症的发生。资料和方法 临床资料 本组例接受PTD并金属支架置入的恶性梗阻性黄疸患者中，男46例，女例，年龄3岁～7岁，平均年龄63岁。患者原发肿