【摘要】目的：探討老年惡性梗阻性黃疸行ERCP或PTBD的臨床 應用 價值。 方法 ：83例惡性梗阻性黃疸患者，男性69例，女性14例，年齡59歲～85歲。其中膽管癌18例，胰頭癌48例，肝癌7例, 轉移癌（胃癌）10 例。所有病例經臨床、病理和影像學檢查診斷為惡性梗阻性黃疸，且失去手術機會。43例行ERCP，40例行PTBD。結果：ERCP內引流成功38例，所有PTBD術全部引流成功，引流術後兩周血清膽紅素水平明顯較 治療 前下降。生存時間最短26 d，最長16個月。結論：ERCP或PTBD對晚期惡性梗阻性黃疸患者是一種良好的降低黃疸的姑息性治療方法。
【關鍵詞】黃疸 梗阻性 介入放射學 治療
Interventional The rapy for Malignant Obstructive Jaundice in Elderly Patients
ZHOU Liang ,FAN Zhining，TANG Jilai,FENG Yuming
The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, China
Abstract： Objective To study the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage ( PTBD) for elderly patients with malignant obstructive jaundice. Methods 83 patients with malignant obstructive laundice were palliated by means of drainage with ERCP and PTBD. Eighteen had cholangiocarcinoma, 48 pancrentic carcinoma,7 primary hepatocellular carcinoma, 10 metastatic caicinoma from carcinoma of stomach. The had US. CT. and (or) MRCP and routine serum laboratory data. 43 had ERCP .40 had PTBD including external drainage and internal-external drainage. All patients were followed for a month with clinical evaluation and laboratory examination. Results 43 patients recEIved ERCP, stent placement was conducted in 28 patients.10 patients received plastic catheters. PTBD were successfully performed in all the patients. 21 had PTBD including external drainage and internal-external drainage. The other 19 patients received stents. The levels of serum total bilirubin(TB) decreased significantly after the procedure. Conclusion ERCP or PTBD is safe , effective for malignant biliary obstruction.
Key words: Jaundice; Obstructive; Interventional radiography; Therapy
老年阻塞性黃疸在臨床上比較常見，這些患者由於臟器機能處於減退狀態，免疫力反應性差，且併發症多，因而增加了對疾病診斷及治療的複雜性。自2005年7月至2007年2月我們共收治阻塞性黃疸患者83例，經內窺鏡逆行胰膽管造影（endoscopic retrograde cholangiopancreatography ERCP）或經皮肝穿膽管造影(percutaneous transhepaticcholangiographyPTC)進一步明確病變部位、範圍、性質後，根據患者綜合情況置入膽管金屬支架、外或內外引流（percutaneous transhepatic biliary drainage，PTBD），病情得到明顯緩解，現報告如下。
1 臨床資料
1.1 一般資料
本組83例，男69例，女14例，年齡59歲～85歲，平均年齡67.8歲，其中肝癌7例，膽管癌18例，胰頭癌48例，胃癌轉移10例。臨床表現為皮膚鞏膜黃染、血清膽紅素及轉氨酶升高。平均血清總膽紅素(TBIL)、直接膽紅素(DBIL)、間接膽紅素(IBIL)、丙氨酸氨基轉移酶(ALT)和門冬氨酸氨轉移酶(AST)分別為(321．6 ±132．1) μmol/L、 (252．3±36．3) μmol/L、(96．1 ±40．7) μmol/L、 (108．2±40．8) IU/L、 (281．8±156．1) IU／L。影像學檢查表現為肝內或肝內、外膽管擴張。選用材料為COOK公司、BOSTON公司PTCD穿刺套裝及引流管，支架為常州新區佳森醫用支架器械有限公司，設備為導津胃腸機、GEINNOVA 3100數字平板DSA。
1.2 方法
43例行ERCP，患者左側俯臥於X線檢查床上，咽部黏膜麻醉後內鏡下找到十二指腸乳頭，38例成功插入導絲及造影管至肝內膽管，行膽管造影，明確梗阻部位、長度後置入國產金屬支架。45例行PTBD（其中5例為ERCP失敗後），15例外引流，17例內外引流，13例置入金屬支架。對於膽總管梗阻金屬支架，頭端稍突出十二指腸乳頭進入腸腔，支架直徑10 mm。
1.3 結果
大多患者病情好轉，膽紅素下降。術後1周複查肝功，平均血清TBIL、DBIL、IBIL、ALT和AST值分別為(178．1±91．4) μmol／L、 (134．9±80．1) μmol／L、 (98．0±46．3) μmol／L、 (51．4±20．9) IU／L、 (73．6±25．7) IU／L，較術前顯著下降(P<0．01)。79例黃疸明顯消退，4例黃疸減退不明顯，系肝內多發膽管狹窄、阻塞，雖左、右兩支引流，引流欠佳。ERCP術後血澱粉酶一過性升高21例，並發胰腺炎2例。PTBD患者膽汁性腹膜炎1例，系有腹水，而患者及家屬要求行PTBD術,造影示膽汁引流管滲漏所致，膽汁瘺1例，更換10F引流管後停止。術後隨訪72例，術後生存時間26 d～16個月，平均生存時間為7.1個月。
轉貼於論文聯盟 http://www.lwlm.com
【關鍵詞】黃疸 梗阻性 介入放射學 治療
Interventional The rapy for Malignant Obstructive Jaundice in Elderly Patients
ZHOU Liang ,FAN Zhining，TANG Jilai,FENG Yuming
The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, China
Abstract： Objective To study the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage ( PTBD) for elderly patients with malignant obstructive jaundice. Methods 83 patients with malignant obstructive laundice were palliated by means of drainage with ERCP and PTBD. Eighteen had cholangiocarcinoma, 48 pancrentic carcinoma,7 primary hepatocellular carcinoma, 10 metastatic caicinoma from carcinoma of stomach. The had US. CT. and (or) MRCP and routine serum laboratory data. 43 had ERCP .40 had PTBD including external drainage and internal-external drainage. All patients were followed for a month with clinical evaluation and laboratory examination. Results 43 patients recEIved ERCP, stent placement was conducted in 28 patients.10 patients received plastic catheters. PTBD were successfully performed in all the patients. 21 had PTBD including external drainage and internal-external drainage. The other 19 patients received stents. The levels of serum total bilirubin(TB) decreased significantly after the procedure. Conclusion ERCP or PTBD is safe , effective for malignant biliary obstruction.
Key words: Jaundice; Obstructive; Interventional radiography; Therapy
老年阻塞性黃疸在臨床上比較常見，這些患者由於臟器機能處於減退狀態，免疫力反應性差，且併發症多，因而增加了對疾病診斷及治療的複雜性。自2005年7月至2007年2月我們共收治阻塞性黃疸患者83例，經內窺鏡逆行胰膽管造影（endoscopic retrograde cholangiopancreatography ERCP）或經皮肝穿膽管造影(percutaneous transhepaticcholangiographyPTC)進一步明確病變部位、範圍、性質後，根據患者綜合情況置入膽管金屬支架、外或內外引流（percutaneous transhepatic biliary drainage，PTBD），病情得到明顯緩解，現報告如下。
1 臨床資料
1.1 一般資料
本組83例，男69例，女14例，年齡59歲～85歲，平均年齡67.8歲，其中肝癌7例，膽管癌18例，胰頭癌48例，胃癌轉移10例。臨床表現為皮膚鞏膜黃染、血清膽紅素及轉氨酶升高。平均血清總膽紅素(TBIL)、直接膽紅素(DBIL)、間接膽紅素(IBIL)、丙氨酸氨基轉移酶(ALT)和門冬氨酸氨轉移酶(AST)分別為(321．6 ±132．1) μmol/L、 (252．3±36．3) μmol/L、(96．1 ±40．7) μmol/L、 (108．2±40．8) IU/L、 (281．8±156．1) IU／L。影像學檢查表現為肝內或肝內、外膽管擴張。選用材料為COOK公司、BOSTON公司PTCD穿刺套裝及引流管，支架為常州新區佳森醫用支架器械有限公司，設備為導津胃腸機、GEINNOVA 3100數字平板DSA。
1.2 方法
43例行ERCP，患者左側俯臥於X線檢查床上，咽部黏膜麻醉後內鏡下找到十二指腸乳頭，38例成功插入導絲及造影管至肝內膽管，行膽管造影，明確梗阻部位、長度後置入國產金屬支架。45例行PTBD（其中5例為ERCP失敗後），15例外引流，17例內外引流，13例置入金屬支架。對於膽總管梗阻金屬支架，頭端稍突出十二指腸乳頭進入腸腔，支架直徑10 mm。
1.3 結果
大多患者病情好轉，膽紅素下降。術後1周複查肝功，平均血清TBIL、DBIL、IBIL、ALT和AST值分別為(178．1±91．4) μmol／L、 (134．9±80．1) μmol／L、 (98．0±46．3) μmol／L、 (51．4±20．9) IU／L、 (73．6±25．7) IU／L，較術前顯著下降(P<0．01)。79例黃疸明顯消退，4例黃疸減退不明顯，系肝內多發膽管狹窄、阻塞，雖左、右兩支引流，引流欠佳。ERCP術後血澱粉酶一過性升高21例，並發胰腺炎2例。PTBD患者膽汁性腹膜炎1例，系有腹水，而患者及家屬要求行PTBD術,造影示膽汁引流管滲漏所致，膽汁瘺1例，更換10F引流管後停止。術後隨訪72例，術後生存時間26 d～16個月，平均生存時間為7.1個月。
轉貼於論文聯盟 http://www.lwlm.com
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