目的 探讨经内镜逆行胰胆管造影术(ERCP)联合改良法经皮经肝胆管引流术(PTCD)治疗恶性梗阻性黄疸的优越性.方法 68例恶性梗阻性黄疸患者先通过EKCP放置胆道支架,ERCP不成功则通过改良法PTCD窦道放置.观察其操作成功率、退黄效果、并发症发生情况、支架通畅期及患者生存期.结果 68例患者中58例通过ERCP成功置入内支架,8例行PTCD经窦道放入金属支架,2例均未能成功,成功率97.1%;所有患者术后瘙瘁、腹痛及发热等临床症状明显改善,肝功能各项转氨酶指标及胆红素水平迅速下降;7例患者支架再次阻塞,1例患者反复发作胆管炎,并发症发生率为11.8%;塑料支架通畅期平均为112 d;金属支架通畅期平均为212 d;患者生存期最短为68d,最长为540d,平均为238d.结论 ERCP及改良法PTCD创伤小,疗效好,可作为无法手术切除或不愿手术的恶性梗阻性黄疸患者的首选治疗.%[Objective]To investigated the superiority of ERCP (endoscopic retrograde cholangiopancreatography) combining improved PTCD (percutaneous transhepatic biliary drainage) in the treatment of the patients with malignant obstructive jaundice.[Methods]68 patients with malignant obstructive jaundice were placed biliary stents through ERCP firstly, and PTCD after ERCP is unsuccessful.The operation success rate, the palliative level of jaundice, the rate of complication, the stent patency period and the survival period of patientswere observed.[Results]Of 68 patients with malignant obstructive jaundice, 58 cases were placed biliary stents via ERCP; 8 via PTCD after it faied.The success rate was 97.1％.Two failed in the stent implantation via either ERCP or PTCD.The clinical symptoms such as pruritus, abdominal pain and fever were improved obviously and the liver function indicators of transaminase and bilirubin levels decreased rapidly in all patients; Stent obstruction happened on 7 cases, recurrent cholangitis occured on 1 patient, complication rate was 11.8％; The average patency period in plastic stent was 112 days and 212 days in metal stent; survival time of patients with a minimum of 68 days, up to a maximum of 540 days, with an average of 238 days.[Conclusions]Because of the diminutive trauma and good efficacy, ERCP and improved PTCD should be the preferred therapy to the patients with inoperable malignant obstructive jaundice or to those wouldn't't rather be operated on.
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