CAJ | 학술논문

目的探讨改良经皮肝穿刺胆道引流术(PTCD)及经皮胆道支架置入在恶性梗阻性黄疸中的治疗价值.方法 33例恶性胆道梗阻患者,采用改良PTCD,并在当时或1～3周后行经皮胆道可膨式金属支架置入.结果改良PTCD成功率100%,支架置入成功率90.9%(30/33).随访1～29个月,中位生存14.8个月.6例随访期间出现发热、黄疸,其中1例重置PTCD后症状缓解,1例抗炎、利胆治疗后症状消失,1例重置PTCD管后黄疸短暂消失,渐出现混合性黄疸,另3例因肿瘤广泛浸润、转移、恶病质,不宜再次PTCD引流.结论 (1)经皮胆道支架置人术的选择性应用,是姑息性治疗恶性梗阻性黄疸的安全有效方法,并能原位恢复胆道的生理连续性;(2)改良PTCD操作是支架置入的前提条件和放置失败的引流保证,也为胆道再梗阻提供了解决的途径.
목적 탐토개량경피간천자담도인류술(PTCD)급경피담도지가치입재악성경조성황달중적치료개치.방법 33례악성담도경조환자,채용개량PTCD,병재당시혹1～3주후행경피담도가팽식금속지가치입.결과 개량PTCD성공솔100%,지가치입성공솔90.9%(30/33).수방1～29개월,중위생존14.8개월.6례수방기간출현발열、황달,기중1례중치PTCD후증상완해,1례항염、리담치료후증상소실,1례중치PTCD관후황달단잠소실,점출현혼합성황달,령3례인종류엄범침윤、전이、악병질,불의재차PTCD인류.결론 (1)경피담도지가치인술적선택성응용,시고식성치료악성경조성황달적안전유효방법,병능원위회복담도적생리련속성;(2)개량PTCD조작시지가치입적전제조건화방치실패적인류보증,야위담도재경조제공료해결적도경.
Objective To investigate the clinical value of improved percutaneous tramhepatic cholangiographic drainage(PTCD)and percutaneous placement of biliary metallic stents on the treatment of malignant obstructive jaundice.Methods Thirty three patients with malignant biliary obstruction were treated by the improved PTCD guided by ultrasound followed by pereutaneous placement of biliary tract metallic stcnts 1～3 weeks later.Results Improved PTCD WaS succeeded in all the patients,30 patients(90.9%)accepted percutaneous placement of biliary metallic stents successfully,3 patients who failed in stents placement accepted PTCD again for palliative management of iallndice.Thofle who failed in stent placement were found to have bleeding from the PTCD tube,but recovered several days later.Jaundice alleviated in all the patients.The patients were followed up for 1～29 months,medium follow-up period is 14.8 months.Six cases were found lever and jaundice,among that,two ageepted improved PTCD again,one recovered after antibioic treatment,the remaining 3 patients failed in further treatment due to the metastasis of the tumor.Condusion Pereutaneous placement of biliary metallic stents after improved PTCD is a safe and effeetive method to relieve malignant biliary obstruction,it can improve life quality,prolong survival time.This method could be a good choice for treating the patients with mnlignant biliary obstruction without operation.