通讯作者: 郭志远, Gzhy1234@163.com

DOI：10.12201/bmr.202611.00021

Short-term efficacy of CT-guided percutaneous transhepatic cholangial drainage for malignant biliary obstruction at different anatomical levels

• 摘要：目的 探讨计算机断层扫描（computed tomography，CT）引导下经皮肝穿刺胆管引流术（percutaneous transhepatic cholangial drainage，PTCD）治疗不同梗阻部位的恶性梗阻性黄疸（malignant obstructive jaundice，MOJ）短期临床效果与安全特征。方法 回顾性收集2022年1月至2026年1月于邯郸市中心医院收治51例确诊为MOJ行CT引导下PTCD患者的临床资料，按照梗阻部位分为低位梗阻组23例和高位梗阻组28例，比较两组临床疗效。结果 低位梗阻组术后7天总有效率为82.61%（19/23），高位梗阻组为67.86%（19/28），差异无统计学意义（P=0.229）；校正原发疾病构成后，梗阻部位与疗效仍无显著关联（校正OR=0.550，95%CI：0.131～2.310，P=0.414）。两组术后7天丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天冬氨酸氨基转移酶（aspartate aminotransferase，AST）、总胆红素（total bilirubin，TBIL）、直接胆红素（direct bilirubin，DBIL）以及间接胆红素（indirect bilirubin，IBIL）均较术前显著下降（P<0.05），但两组间肝功能指标术前术后差值比较差异均无统计学意义（P>0.05）；两组技术成功率均为100%，穿刺时间比较差异无统计学意义（P>0.05）；高位梗阻组和低位梗阻组并发症发生率比较差异无统计学意义（3.57% vs 8.70%，P=0.583）。结论 CT引导下PTCD对两组减黄具有相当的近期疗效和安全性，在临床决策不宜仅依据梗阻平面，还应结合全身状况、胆管扩张程度、预期生存和技术可及性综合判断。

  关键词： CT引导；经皮肝穿刺胆管引流；恶性梗阻性黄疸；低位梗阻；高位梗阻; ; ; ; 

   

  Abstract: Objective To compare the short-term efficacy and safety of computed tomography (CT)-guided percutaneous transhepatic cholangial drainage (PTCD) for malignant obstructive jaundice at different anatomical levels. Methods This retrospective study enrolled 51 patients with malignant obstructive jaundice who underwent CT-guided PTCD at Handan Central Hospital between January 2022 and January 2026. Based on the anatomical level of biliary obstruction, the patients were divided into a low-level obstruction group (n = 23) and a high-level obstruction group (n = 28). The short-term clinical outcomes were compared between the two groups. Results The overall response rate at postoperative day 7 was 82.61% (19/23) in the low-level obstruction group and 67.86% (19/28) in the high-level obstruction group, with no statistically significant difference between the two groups (P = 0.229). After adjustment for the primary disease composition, the obstruction level remained unassociated with treatment response (adjusted OR = 0.550, 95% CI: 0.131–2.310, P = 0.414). At postoperative day 7, alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL), and indirect bilirubin，(IBIL )levels decreased significantly from baseline in both groups (all P < 0.05); however, the pre-to-postoperative changes in these parameters did not differ significantly between the two groups (all P > 0.05). The technical success rate was 100% in both groups, and the puncture time was comparable between the two groups (P > 0.05). The complication rates did not differ significantly between the high-level and low-level obstruction groups (3.57% vs. 8.70%, P = 0.583). Conclusion CT-guided PTCD provides comparable short-term efficacy and safety for jaundice relief across different levels of biliary obstruction. Clinical decision-making should incorporate a comprehensive, multidimensional assessment of patient-specific requirements for biliary decompression rather than relying solely on the anatomical level of obstruction.

  Key words: CT-guided; percutaneous transhepatic cholangial drainage; malignant obstructive jaundice; hilar biliary obstruction; distal biliary obstruction

  提交时间：2026-11-14

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• 序号	提交日期	编号	操作
  1	2026-10-15	10.12201/bmr.202611.00021V1	下载

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