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目的 探讨胆道金属支架治疗恶性阻塞性黄疸(MOJ)的临床疗效. 方法 回顾性分析1998年2月至2009年2月的241例MOJ患者临床资料,所有患者均接受经皮肝穿刺胆道金属支架置入术.评价预后以死亡为研究终点,随访时间截至2010年2月,统计学分析比较患者生存期及治疗前后各实验室指标改变,评价疗效.计数资料采用x2检验,计量资料用t检验;生存率比较采用Kaplan-Meier法；Cox回归模型评估各危险因素对生存时间的影响. 结果 支架置入技术成功率为100％.支架置入术后4周内血清胆红素下降明显(P＜ 0.05),术后院内死亡11例,失访28例,202例获得完整随访资料；随访时间为8～ 193周,其13周、26周、39周、52周的生存率分别为87％、66％、56％、41％,中位生存期为43.55周.同期支架通畅率分别为70％、46％、36％和24％,平均通畅时间为27.57周.Cox回归分析示:术前胆红素＜ 221 μmol/L(P=0.01)及术后胆红素下降比例超过50％(P=0.002)者预后较好.结论 胆道金属支架置入术治疗MOJ技术安全、可行,可有效缓解黄疸症状,延长生存期.高胆红素血症及胆红素下降程度低于50％是影响MOJ患者生存率的因素.

Objective To evaluate the clinical efficacy of implanted biliary metallic stents in the management of malignant obstructive jaundice (MOJ).Methods Percutaneous transhepatic cholangiography and stent insertion were performed in 241 consecutive patients to treat malignant biliary obstruction between December 1998 and February 2009.The study end point was patient death.All patients were followed-up until death or until February 2010.The therapeutic efficacy was determined by statistical analysis of life span and pre-and post-operative laboratory indices.Results All 241 patients were successfully stented.The level of bilirubin descended obviously within four weeks of implantation (P ＜ 0.05),and the early mortality rate was 4.56％ (11/241).Two-hundred-and-two patients were followed-up (range:8-193 weeks posttransplantation) and showed a median survival of 43.55 weeks.The survival rates at 13,26,39 and 52 weeks post-transplantation were 87％,66％,56％,and 41％,respectively.The stent patency rates at 13,26,39 and 52 weeks post-transplantation were 70％,46％,36％ and 24％,respectively; the mean stent patency was 27.57weeks.Cox regression analysis identified the strong predictors of improved survival as an initial bilirubin level of ＜221 μmol/L (P =0.01) and a stent-induced bilirubin reduction of ＞50％ (P =0.002).Conclusion Transhepatic metallic biliary stenting is a safe and effective therapeutic intervention for malignant biliary obstruction.Significant periods of survival and palliation of jaundice can be achieved with this method.Hyperbilirubinemia and a stent-induced bilirubin reduction of ＜50％ are independent predictive factors for the survival of MOJ patients.