Makino Tomoki, Fujitani Kazumasa, Tsujinaka Toshimasa, Hirao Motohiro, Kashiwazaki Masaki, Nakamori Shoji, Ikenaga Masakazu, Mishima Hideyuki, Masuda Norikazu, Sawamura Toshiro
Department of Surgery, Osaka National Hospital, Chuo-ku, Osaka, Japan.
Hepatogastroenterology. 2008 Jan-Feb;55(81):54-7.
BACKGROUND/AIMS: We reviewed the medical records of patients with obstructive jaundice caused by the local recurrence of gastric cancer to clarify the role of percutaneous transhepatic biliary drainage (PTBD).
Eleven patients with a mean age of 60.1 years (range: 51-71 years) underwent PTBD because of obstructive jaundice caused by the extrahepatic recurrence of gastric cancer.
Jaundice was relieved in all the patients, and the serum total bilirubin (T-bil) level decreased from 12.2 to 2.1 mg/dL. No major complications associated with the execution of PTBD occurred. Although various symptoms caused by jaundice, such as anorexia, itching, nausea, abdominal pain, and fever, were relieved in all the patients within one week after PTBD, general fatigue persisted in 3 patients and abdominal fullness persisted in one. Seven of the 11 patients were discharged from the hospital after the execution of PTBD and remained at home for a median of 93 days. The median survival time (MST) of the remaining 4 patients who could not be discharged was 48 days. Chemotherapy was added in 5 patients after the execution of PTBD; these patients exhibited a significantly longer MST of 247 days, compared to 62 days among the patients who did not receive chemotherapy (P=0.0176).
PTBD was safely conducted and improved the quality-of-life of patients with obstructive jaundice caused by the local recurrence of gastric cancer. Furthermore, the use of chemotherapy after PTBD might prolong patient survival although RCT (randomized controlled trial) study should be performed to assess the precise effect of chemotherapy after PTBD.
背景/目的：我们回顾了因胃癌局部复发导致梗阻性黄疸患者的病历，以阐明经皮经肝胆道引流术（PTBD）的作用。
11例平均年龄60.1岁（范围：51 - 71岁）的患者因胃癌肝外复发导致梗阻性黄疸接受了PTBD。
所有患者黄疸均缓解，血清总胆红素（T-bil）水平从12.2mg/dL降至2.1mg/dL。未发生与PTBD实施相关的重大并发症。尽管PTBD术后1周内所有患者黄疸引起的各种症状，如厌食、瘙痒、恶心、腹痛和发热均得到缓解，但仍有3例患者持续存在全身乏力，1例患者持续存在腹胀。11例患者中有7例在PTBD术后出院，在家中平均停留93天。其余4例无法出院的患者中位生存时间（MST）为48天。5例患者在PTBD术后接受了化疗；与未接受化疗的患者相比，这些患者的MST显著延长，为247天，而未接受化疗的患者为62天（P = 0.0176）。
PTBD实施安全，改善了因胃癌局部复发导致梗阻性黄疸患者的生活质量。此外，PTBD术后使用化疗可能会延长患者生存期，尽管应进行随机对照试验（RCT）研究以评估PTBD术后化疗的确切效果。
