Born P, Neuhaus H, Rösch T, Lorenz R, Classen M
Department of Internal Medicine II, Klinikum r. d. Isar, Technical University of Munich.
Z Gastroenterol. 1996 Jul;34(7):416-20.
In patients with both duodenal and biliary obstruction in whom endoscopic drainage is not feasible, the standard approach has been gastroenterostomy plus biliodigestive anastomosis. We present our results of percutaneous biliary drainage in combination with gastroenterostomy.
Twenty-one patients, who received permanent percutaneous transhepatic biliary drainage (PTBD) and gastroenterostomy in case of symptomatic gastric outlet obstruction were retrospectively evaluated.
PTBD insertion succeeded in all patients; minor complications were encountered in 47.6% of cases. Bilirubin fell from 9.2 mg/dl (SD 7.6) to 4.9 mg/dl (SD 3.6). Gastroenterostomy, either open (n = 10) or laparoscopic (n = 6), had to be performed in 16 patients before, during or after PTBD. Thirty day mortality was 23.8%, not related to the procedure, but due to advanced neoplastic disease. Mean survival and hospital stay were 4.9 months (SD 3.6) and 21.5 days (SD 7.3) respectively.
The combination of PTBD and gastroenterostomy offers a promising alternative to surgery. However efforts to reduce complications as well as the duration of hospital stay are necessary.
对于十二指肠和胆管均梗阻且无法进行内镜引流的患者，标准治疗方法是胃造口术加胆肠吻合术。我们展示了经皮胆道引流联合胃造口术的治疗结果。
回顾性评估了21例因症状性胃出口梗阻接受永久性经皮肝穿胆道引流（PTBD）和胃造口术的患者。
所有患者PTBD置管均成功；47.6%的病例出现轻微并发症。胆红素从9.2mg/dl（标准差7.6）降至4.9mg/dl（标准差3.6）。16例患者在PTBD之前、期间或之后必须进行胃造口术，其中开放手术10例，腹腔镜手术6例。30天死亡率为23.8%，与手术无关，而是由于晚期肿瘤疾病。平均生存期和住院时间分别为4.9个月（标准差3.6）和21.5天（标准差7.3）。
PTBD与胃造口术联合使用为手术提供了一种有前景的替代方案。然而，有必要努力减少并发症以及缩短住院时间。
