Bear H D, Turner M A, Parker G A, Lawrence W, Horsley J S, Messmer J M, Cho S R
Division of Surgical Oncology, Medical College of Virginia Station, Richmond 23298-0011.
Am J Surg. 1989 Apr;157(4):381-5; discussion 385. doi: 10.1016/0002-9610(89)90580-1.
Over an 8-year period, among 41 patients with obstructive jaundice caused by metastases to the liver or lymph nodes adjacent to the porta hepatis, palliative biliary decompression was established surgically in 11, by percutaneous transhepatic biliary drainage (PTBD) in 25, and by both methods in 2. Three patients had no drainage procedure performed. Early mortality after drainage occurred in 6 of 38 patients, and the median survivals (actuarial) for the remaining 32 patients were 4.5 months for the surgical group (range 2 to 21 months) and 4 months for the PTBD group (range 2 to 14 months). Although there were trends toward more frequent hospital readmissions and episodes of cholangitis in the PTBD group, the only statistically significant difference was in the number of catheter manipulations required. We concluded that when patients develop obstructive jaundice as a manifestation of metastatic cancer, useful palliation can be achieved by either surgical or percutaneous decompression.
在8年期间，41例因肝转移或肝门旁淋巴结转移导致梗阻性黄疸的患者中，11例接受了手术姑息性胆道减压，25例接受了经皮肝穿胆道引流（PTBD），2例接受了两种方法。3例未进行引流手术。38例患者引流后早期死亡率为6例，其余32例患者的中位生存期（精算），手术组为4.5个月（范围2至21个月），PTBD组为4个月（范围2至14个月）。虽然PTBD组有更频繁的住院再入院和胆管炎发作趋势，但唯一具有统计学意义的差异在于所需的导管操作次数。我们得出结论，当患者因转移性癌症出现梗阻性黄疸时，手术或经皮减压均可实现有效的姑息治疗。
