摘要
目的回顾性分析老年恶性梗阻性黄疸患者的介入治疗方法及近期疗效和影响黄疸消退的因素。方法29例70岁以上患者，男19例，女10例，平均74．5岁。其中肝癌6例，胆管癌9例，胆囊癌3例，胰腺癌8例，转移癌3例。梗阻部位在胆总管13例，肝总管肝门区以上16例。10例单纯外引流或内外引流，19例放置了胆道支架，所用支架6种20枚，术后1周造影或摄片复查。术前、术后查血生化全项，分析影响黄疸消退的因素。结果复查时引流通畅，支架扩张良好。黄疸消退19例明显，2例比较明显，8例不明显。留置支架者胆红素由（347．13±136．29）μmol／L降至（222．30±116．45）～（117．82±87．72）μmol／L；单纯外引流者由（448．02±96．79）μmol／L降至（292．41±135．26）～（119．36±162．11）μmol／L，单纯引流与留置支架效果无明显区别。引流术后早期出现并发症13例，死亡7例。发现黄疸消退与肿瘤类别、术前尿素氮、术后白蛋白、α-羟丁氨酸脱氢酶及尿素氮相关；与梗阻部位、胆红素、丙氨酸转移酶、碱性磷酸酶无明显相关性。结论介入治疗恶性黄疸方法简单、疗效确实。但对高龄患者治疗时应严格掌握其适应证。
Objective To analyze the short-term results of interventional therapy for elderly patients with malignant obstructive jaundice, and the relevant factors. Methods 29 patients over 70 with malignant obstructive jaundice were palliated by means of drinage with PTBD and (or) PTBS Six had primary hepatocellular carcinoma, 9 cholangiocarcinoma 3 adenocarcinoma of gallbladder, 8 pancreatic carcinoma, and the remaining 3 metastatic carcinoma from a variety of primary sites. The obstruction was at the level of liver hilum in 16 cases, in common bile duct in 13. They had US, CT and (or) MRCP, and routine serum laboratory data. We used routinely antibiotic and coagulin. After receiving pereutaneous cholangiography, 10 had PTBD including external drainage and intemal-extemal drainage. 19 PTBS included 11 combined external drinage. All patients were followed for a month with clinicla evaluation and laboratory examination. Results All were patent at 1 week's follow-up. Serum total bilirubin(TB)was reduced from (388. 17 ±131 .33) μmol/L before operation to (251 .37±126.37)μmol/L after a week, and to (118.33 ±111.49) μmol/L after 2 weeks. Serum TB of those receiving PTBS was reduced from (347.13±136.29) to (222.3 ±116.45) μmol/L and to (117.82 ± 87.72) μmol/L, and TB of those receiving PTBD was reduced from (448.02 ±96.79)to (292.41 ±135.26) μmol/L and to (119.36 ±162. 11) μmol/L. The 30 day mortality was 7 cases. Short-term complications occurred in 13 cases: pains 3, cases infections 8, hemorrhages 3, multiorgan failure 3, and hapatic coma 4. The kind of tumor, renal function, and serum GB and HBDH after operation, were the factors influencing the clinical results. The site of obstruction,serum TB, ALT, ALP, and GGT etc had no correlation with the palliative results Conclusion Interventionaltherapy is simple, safe, and effective for malignant biliary obstruction. It is important to adhere to the proper indication for elder patients.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2000年第5期342-344,共3页
Chinese Journal of Radiology
关键词
恶性梗阻性黄疸
介入疗法
介入性放射学
老年人
Cholestasis
Bile duct obetruction, extrahepatic
Radiology, interventional
