CAJ | 학술논문

目的探讨经皮介入治疗肝癌合并胆管癌栓致梗阻性黄疸的方法和临床价值.方法回顾性分析16例经病理及影像检查证实为肝癌合并胆管癌栓造成梗阻性黄疸的患者资料,16例均行经皮穿刺造影后置管引流术,根据患者置管后的临床表现,分别采用永久性外引流、内引流定期调整引流管以及覆膜支架植入等治疗方法,术后检测血清总胆红素(TBIL)水平,并采用配对t检验与术前对比,根据TBIL下降情况及临床症状缓解情况来评价治疗的有效性,并在2年的随访期限内观察患者生存期.结果 16例穿刺引流均获得成功,其中永久性外引流2例,内引流并定期调管7例,留置覆膜支架7例.16例经皮介入治疗前总胆红素平均为(261.9±77.2)μmol/L,治疗后2周为(161.2±80.5)μmol/L,差异有统计学意义(t=7.366,P<0.01).16例生存时间为30～391 d,平均生存时间204 d,中位生存时间为200 d.穿刺引流的主要并发症为出血和感染,经止血及抗炎等常规治疗可有效控制.结论对于肝癌合并胆管癌栓所致的梗阻性黄疸,经皮介入治疗技术成功率高,临床疗效较好.
목적 탐토경피개입치료간암합병담관암전치경조성황달적방법화림상개치.방법 회고성분석16례경병리급영상검사증실위간암합병담관암전조성경조성황달적환자자료,16례균행경피천자조영후치관인류술,근거환자치관후적림상표현,분별채용영구성외인류、내인류정기조정인류관이급복막지가식입등치료방법,술후검측혈청총담홍소(TBIL)수평,병채용배대t검험여술전대비,근거TBIL하강정황급림상증상완해정황래평개치료적유효성,병재2년적수방기한내관찰환자생존기.결과 16례천자인류균획득성공,기중영구성외인류2례,내인류병정기조관7례,류치복막지가7례.16례경피개입치료전총담홍소평균위(261.9±77.2)μmol/L,치료후2주위(161.2±80.5)μmol/L,차이유통계학의의(t=7.366,P<0.01).16례생존시간위30～391 d,평균생존시간204 d,중위생존시간위200 d.천자인류적주요병발증위출혈화감염,경지혈급항염등상규치료가유효공제.결론 대우간암합병담관암전소치적경조성황달,경피개입치료기술성공솔고,림상료효교호.
Objective To explore the method and value of percutanously interventional therapeusis for treatment of obstructive jaundice caused by hepatocellular carcinoma accompanied with bile duct thrombosis.Methods Sixteen cases with bile duct thrombosis proved by pathology and imaging examinations were retrospectively analyzed.According to the clinical symptoms, all the patients received percutaneous transhepatic biliary drainage (PTBD) including permanent external drainage, temporary internal drainage and implantation of covered stents.Serum total bilirubin (TBIL) after the interventional therapeusis were measured and compared with that before the treatments by t test to evaluate the efficacy of these treatments.The relief of clinical symptoms was also reviewed to evaluate the efficacy of these treatments.The patients were followed up within 2 years.Results The PTBD was successfully performed in 16 cases.Permanent external drainage, temporary internal drainage and implantation of covered stents were performed in 2 patients, 7 patients and 7 patients respectively.TBIL after the interventional therapy decreased significantly (t=7.366, P<0.01) to (161.2±80.5) μmol/L averagely from (261.9±77.2)μmol/L before the treatments.All the patients died before the end of followed-up.The average survival time was 204 days (30 to 391 d)and the median survival time was 200 days.Bleeding and infection were the main complications, which could be controlled successfully by routine treatments.Conclusion With high achievement ratio and good efficacy, percutanously interventional therapeusis are good choices for the treatments of obstructive jaundice due to bile duct thrombosis.