王清泉

[摘要] 目的 評价DAS介导下PTBD联合胆道支架植入、传统手术治疗恶性胆道梗阻的疗效与安全性。方法 回顾性分析2011年2月—2015年2月医院收治的姑息治疗恶性胆道梗阻患者入组，其中方便选择传统经内镜逆行胰胆管造影置管引流手术对象76例纳入对照组，同期方便选择DSA介导下经皮肝穿胆道引流（PTBD）联合胆道支架植入术51例纳入观察组。对比手术、引流、住院情况以及预后、并发症发生情况。结果 观察组术中出血量、引流时间分别为（34.4±6.5）mL、（17.4±8.6）d，对照组分别为（51.4±8.3）mL、（22.8±8.4）d，观察组优于对照组，差异有统计学意义（P<0.05），两组手术时间、住院时间差异无统计学意义（P>0.05）。观察组术后1周总胆红素下降幅度、黄染控制时间、术后1周KPS评分、支架通畅时间分别为（46.6±15.6）%、（4.7±1.5）d、（72.5±11.5）分、（6.2±0.5）个月、（5.6±13.5）个月、对照组分别为（33.8±12.9）%、（7.5±1.8）d、（70.2±13.6）分、（5.8±0.3）个月、（4.6±12.5）个月，两组差异有统计学意义（P<0.05）。观察组并发症合计发生率为54.9%，低于对照组的72.4%，差异有统计学意义（P<0.05）。结论 DSA介导下经皮肝穿胆道引流（PTBD）联合胆道支架植入术相较于传统手术，引流、降黄效果更好，还可降低并发症发生风险。

[关键词] 恶性胆道梗阻；DSA介导；经皮肝穿胆道引流；胆道支架植入

[中图分类号] R442 [文献标识码] A [文章编号] 1674-0742（2018）02（a）-0043-04

The Safety and Efficacy of DSA-mediated Percutaneous Transhepatic Bile Duct Drainage（PTBD） Combined with Biliary Stent Implantation and Traditional Surgery in the Treatment of Malignant Biliary Obstruction

WANG Qing-quan

Department of General Surgery， Lubei High and New Technology Development Zone Peoples Hospital， Binzhou， Shandong Province， 251900 China

[Abstract] Objective This paper tries to evaluate the efficacy and safety of DAS-mediated PTBD combined with biliary stent implantation and traditional surgical in treatment of malignant biliary obstruction. Methods From February 2011 to February 2015， the data of palliative treatment of malignant biliary obstruction were retrospectively analyzed. Among them， 76 cases were treated by endoscopic retrograde cholangiopancreatography， and were included in the control group. At the same time， 51 patients with percutaneous transhepatic bile duct drainage （PTBD） and biliary tract stent implantation were convenient selected and were divided into observation group， comparison of surgery， drainage， hospitalization and prognosis， complications occurred of the two groups. Results The blood loss， drainage time in observation group were （34.4±6.5）mL，（17.4±8.6）d， control group were （51.4±8.3）mL， （22.8±8.4）d， the observation group was better than the control group and the difference was significant （P<0.05）. There was no significant difference in operation time and hospitalization time between the two groups （P>0.05）. 1 week after the reduction of total bilirubin， stained yellow control time， postoperative 1 week KPS score， stent patency of observation group were （46.6±15.6）%， （4.7±1.5）d， （72.5±11.5）points， （6.2±0.5）months， （5.6±13.5）months， control group were （33.8±12.9）%， （7.5±1.8）d， （70.2±13.6）points， （5.8±0.3）months， （4.6±12.5）months， there was significant difference between the two groups （P<0.05）. The incidence of complications in the observation group was 54.9%， which was lower than that of the control group（72.4%）， the difference was statistically significant （P<0.05）. Conclusion DSA-mediated percutaneous transhepatic bile duct drainage（PTBD） combined with biliary stent implantation is more effective than traditional surgery， which has good effect in drainage and strained yellow dropping， and can reduce the risk of complications.

[Key words] Malignant biliary obstruction； DSA-mediated； Percutaneous transhepatic bile duct drainage； Biliary stent implantation

恶性胆道梗阻（MBO）是指胆管癌、胆囊癌、胰腺癌等恶性肿瘤侵犯以及压迫肝外胆道引起胆汁淤积引起黄染、高胆红素血症等一系列临床表现与病理表现的疾病[1]。手术是治疗恶性肿瘤的唯一根治方法，但大多数无法耐受，仅10%～20%的患者可采用手术切除，采用姑息治疗非常必要，否则可能会导致肝功能严重下降，无法引流者平均生存期不足3个月，而通畅引流者平均生存期可延长到6～7个月[2]。对于恶性胆道梗阻治疗姑息治疗包括传统引流术、经皮经肝穿刺置管引流术（PTCT）、自膨金属支架（SEMS）。该次研究采用对比分析，对2011年2月—2015年2月该院收治的76例恶性胆道梗阻患者进行研究，评价DAS介导下PTBD联合胆道支架植入、传统手术治疗恶性胆道梗阻的疗效与安全性，现报道如下。……