探讨肝门部胆管癌引起的高位多支复杂类型梗阻性黄疸的介入引流方法和临床疗效。

选取因肝门部胆管癌引起的多支复杂类型梗阻性黄疸患者38例，其中男28例，女10例。Bismuth-Corlett分型Ⅱ型6例，Ⅲ型18例，Ⅳ型14例。根据胆道梗阻的部位、范围、各分支梗阻情况及胆道扩张的程度，对不同类型患者的引流方案进行个体化设计。其中30例单纯采取了引流管引流，并根据需要对引流管临时剪孔，每例放置1~3条胆道外引流管。8例Ⅳ型肝门部胆管癌根据左右肝管分支角度不同分别采取了不同的方法进行胆道双支架置入。

全部病例介入引流手术过程顺利，除2例合并少量胆道出血外，无其他严重并发症发生。术后患者黄疸明显减轻或消退，皮肤瘙痒和胆管炎等症状逐渐消失。术后1~2周，血清胆红素水平由术前的（242.69±27）μmol/L降至（58.32±5.6）μmol/L，差异有统计学意义（t=9.73，P<0.05），收到了较好的近期治疗效果。8例行胆道双支架置入患者中有3例分别于术后4~6个月发生支架再阻塞，黄疸复发，再次行经皮肝穿刺胆道引流治疗。

肝门部胆管癌高位胆道梗阻病变复杂，通过引流管剪孔，可在保证引流效果的前提下尽量减少引流管的个数，减少了创伤，方便了术后生活和引流管护理，是对普通胆道外引流管的改良。双支架置入对肝门部Bismuth-Corlett Ⅳ型胆管癌近期疗效可靠，根据左右肝管分叉角度采取不同的双支架置入术式方法可行。

To investigate the interventional draining method and clinical therapeutic effect in proximal complicated multibranch biliary obstruction caused by hilar cholangiocarcinoma.

A total of 38 patients with hilar cholangiocarcinoma were enrolled, including 28 males and 10 females. Among them, there were 6 cases of Bismuth-Corlett II, 18 cases of type III, and 14 cases of type IV. Based on the obstructive position, extent, and dilated degree of the biliary tract, individual designs were made for the drainage scheme in the different cases. In 30 cases, the simple drainage tubes were adopted and the drainage tubes were improved by cutting lateral aperture, 1-3 pieces of the tube were inserted for individual patient. In 8 cases, double biliary stents were implanted and different implanting methods were adopted according to the branch angles of left and right hepatic ducts.

The interventional draining operations were successfully completed in all cases and no severe complication happened except for slight hemobilia in 2 patients. The jaundice of all the patients was alleviated or disappeared obviously after the operations, itch of skin and the symptom of cholangitis dribbled away. The serum total bilirubin level was lowered from preoperative (242.69±27) μmol/L to (58.32±5.6) μmol/L after 1-2 weeks of the operation (t=9.73, P<0.05) . Stent restenosis happened and jaundice relapsed in 3 cases after 4-6 months of stent implantations, respectively, and biliary external drainages were made once again.

It is demonstrated that the improved method of cutting lateral aperture on the drainage tube is convenient with reduced trauma and satisfactory curative effect, a single drainage tube can be used to drain the obstructive bile of more biliary branches, or the general external drainage tube can produce the effect of exterior and interior drainage tube. According to the hepatic ducts branch angle, adopting different stent inserting methods is practicable.