目的：探讨经皮肝穿刺胆管引流术（PTCD）基础上胆道内置入金属支架姑息性治疗恶性胆道梗阻的疗效。方法：回顾性分析2011 年1 月—2013 年6 月收治的经十二指肠镜逆行胰胆管造影（ERCP）支架植入失败后改行PTCD 或PTCD 联合胆道内金属支架置入的94 例胆道恶性梗阻患者临床资料，其中，单纯行PTCD 45 例（PTCD 组），PTCD 联合胆道内金属支架置入49 例（PTCD+ 支架组），比较两组减黄效果、术后并发症及术后生存情况。结果：术后5 d，两组血清胆红素水平无统计学差异（P>0.05），但术后7、14 d，PTCD+ 支架组血清胆红素水平明显低于PTCD 组（P<0.05）；两组术后并发症发生率差异无统计学意义（P>0.05）；PTCD+ 支架组术后1 年的生存率优于PTCD 组（χ2=6.280，P=0.012）。结论：PTCD 基础上胆道内金属支架置入是恶性胆道梗阻患者ERCP 失败后有效的姑息性治疗手段，且效果优于单独的PTCD。
Efficacy analysis of percutaneous transhepatic cholangial drainage plus metal stent placement in palliative treatment of malignant biliary obstruction
Objective: To evaluate the efficacy of percutaneous transhepatic cholangial drainage (PTCD) plus biliary metal stent placement in palliative treatment of malignant biliary obstruction. Methods: The clinical data of 94 patients with malignant biliary obstruction admitted between January 2011 and June 2013, who underwent PTCD alone or in combination with biliary metal stent placement after failure of endoscopic retrograde cholangiopancreatography (ERCP) with stent placement, were retrospectively analyzed. Of the patients, 45 cases underwent PTCD treatment alone (PTCD group), and 49 cases underwent PTCD plus biliary metal stent placement (PTCD plus stent group). The degree of jaundice reduction, incidence of postoperative complications and survival between the two groups were compared. Results: The serum bilirubin levels at 5 d after operation showed no significant difference between the two groups (P>0.05), but were significantly lower at 7 and 14 d after operation in PTCD plus stent group than those in PTCD group (P<0.05); There was no significant difference in incidence of postoperative complications between the two groups (P>0.05); the 1-year postoperative survival in PTCD plus stent group was better than that in PTCD group (χ2=6.280, P=0.012). Conclusion: PTCD plus metal biliary stent placement is an effective palliative treatment for malignant biliary obstruction in patients with ERCP failure, moreover, it is superior to PTCD alone treatment.