惡性阻塞性黃疸的內引流術－經皮穿肝膽管引流術的改良方法

International Drainage for Malignant Obstructive Jaundice-A Modified Method of PTCD

衛優遊(Y. Y. Wai) ； 張明瑞(M. Z. Chang) ； 祁志勵(C. L. Kea) ； 蔡春泉(C. C. Tsai)

《中華放射線醫學雜誌》 3卷4期 (1978/12) Pp. 326-331

摘要

對惡性腫瘤引起的阻塞性黃疸，經皮穿肝膽管引流術(percutaneus transhepatic cholangiodrainage，PTCD)把膽汁引流到體外，不失為一有效的治療方法。但大量膽汁外流的結果，引起消化、吸收和水分電解質平衡等問題。本文敘述PTCD的一種改良方法。即用一多側孔的管子，經由PTCD，穿過阻塞的地方，通達十二指腸，使膽汁能內引流至十二指腸，解決上述的問題。PTCD內引流術的併發症不會比PTCD多，而病人不必經過消耗體力的剖腹手術就能使膽汁通過阻塞，流入十二指腸，維持一較正常的生活，實在是一可行的方法。

並列摘要

Most inoperable tumor involving the hilum of the liver, the common hepatic duct, the common bile duct or periampullary region induces obstructive jaundice. Percutaneous transhepatic cholangiodrainage (PTCD) is used as a common method for external drainage of bile with marked improvement in the treatment of obstructive jaundice. However, total external drainage of the bile results in poor digestion, poor absorption as well as water-electrolytes imbalance. Internal drainage of bile by inserting a polyethylene tube with multiple side holes beyond the obstruction via PTCD is a modified method for solving these problems. The indication of internal drainage is mainly in malignant obstructive jaundice. Because PTCD external drainage only is sufficient for pre-operative decompression in most operable obstructive jaundice caused by benign lesion. The complication of internal drainage via PTCD is the same as PTCD only. The patient can discharge within 10 days after the patient or a relative is instructed to handle the daily lavage of the catheter under sterile condition. PTCD internal drainage is a simple, sale and non-operated method for palliative treatment in malignant obstructive jaundice.