胆管支架和(或)引流术治疗恶性胆管梗阻30天内死亡原因分析(2)
原发性 癌及高位胆管癌，尤其是肝内有实性占位病变者，常导致高位多段多处胆管梗阻，因列法将梗阻的各支胆管均上流通畅，使胆管引流疗效较差。有的看似梗阻的胆管主支虽得以引流，但清胆红素工无下，其原因在于原发性肝癌及晚期胆管癌患者的肝脏功能受损明显，已不单纯是梗阻性黄疸，而是肝性黄疸与梗阻性黄疸并存，这类患者行胆管引流，并不能解除黄疸，延长其生存期，应以保肝支持对症治疗为主。因此，在行胆管引流术前，应全面了解病情，分析其肝能及黄疸的主要原因，估计生存期在1个月以上者，可对其进行胆管引流。本组以肝门淋巴结转移瘤致胆管外压性狭窄、胰头癌、胆部管得行胆管支架及引流术疗效较好 ，梗阴性黄疸解除明为。术后加肿瘤局部化疗及胆管支架内近距离放疗，最长生存期达15个月。30d内死亡的12例以原发性肝癌及高位胆管癌为主。
总之，胆管支架和(或)引流术为姑息性治疗，其损伤小，对肝功能较好、胆管中低位梗阻者效果较好。但对肝功能差者，易引严重的并发症。对肝癌及肝内胆管高位梗阻者，引流很难做到较为彻底。对全身情况差并伴有中量腹水者无治疗意义。
参 考 文 献
1. Gordon RL, Ring EJ, LaBenge JM, et al. Malignant biliary obstruction:treatment with expandable metallic stents-follow-up of 50 consecutive patients. Radiology, 1992, 182: 697-701.
2. Boguth L, Taatalovic S, Antonucci F, et al. Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metal prostheses. Radiology, 1994, 192:669-674.
3. Mathieson JR, McLoughlin RF, Cooperberg PL, et al. Malignant obstruction of the common bile duct : long-tem results of gianturco-rosch metal stents used as initial treatment. Radiology, 1994, 192:663-667.
4. Carrasco C,Zornoza, J, Bechtel WJ. Malignant biliaryh obstruction: complication of percutaneous biliary drainage. Radiology, 1984, 152: 343-346., 百拇医药(于平)
总之，胆管支架和(或)引流术为姑息性治疗，其损伤小，对肝功能较好、胆管中低位梗阻者效果较好。但对肝功能差者，易引严重的并发症。对肝癌及肝内胆管高位梗阻者，引流很难做到较为彻底。对全身情况差并伴有中量腹水者无治疗意义。
参 考 文 献
1. Gordon RL, Ring EJ, LaBenge JM, et al. Malignant biliary obstruction:treatment with expandable metallic stents-follow-up of 50 consecutive patients. Radiology, 1992, 182: 697-701.
2. Boguth L, Taatalovic S, Antonucci F, et al. Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metal prostheses. Radiology, 1994, 192:669-674.
3. Mathieson JR, McLoughlin RF, Cooperberg PL, et al. Malignant obstruction of the common bile duct : long-tem results of gianturco-rosch metal stents used as initial treatment. Radiology, 1994, 192:663-667.
4. Carrasco C,Zornoza, J, Bechtel WJ. Malignant biliaryh obstruction: complication of percutaneous biliary drainage. Radiology, 1984, 152: 343-346., 百拇医药(于平)