目的　探讨微创法经皮肝穿胆道引流术 (PTBD)治疗恶性梗阻性黄疸有效方法。资料与方法　对 14 5例恶性梗阻性黄疸患者分别行微创法PTBD ,所有患者均行CT、MRI或B超等影像学及血液生化检查诊断为恶性梗阻性黄疸。男 88例 ,女 5 7例 ,平均年龄 5 8.3± 11 .7岁。PTBD穿刺成功率为 10 0 %。 131例在电视透视下穿刺右肝管 ,其中右前支 12 5例 ,右后支 6例 ;14例在B超引导下穿刺肝管 (其中 12例左肝管外支 ,2例右后支肝管 )。结果　 88例行右支内外引流 ,4 1例行单纯外引流 (其中 39例行右支外引流 ,2例行左支外引流 ) ,8例行联合右支内外引流及左支外引流 ,8例行左支内外引流 ;外引流患者中 35例经 1～ 2周外引流后 ,再成功转为内外引流。另 6例持续带管行外引流。置入引流后较术前血清总胆红素下降明显 (P <0 .0 5 ) ,患者全身状况改善 ,血清谷丙转氨酶下降具有显著性 (P <0 .0 5 ) ,外引流组与内外引流组术前、术后胆红素下降也具显著性 (P <0 .0 5 ) ,并且两组之间术前具有可比性 (P >0 .0 5 )。并发症发生率为 6 .9% ,包括胆道感染 6例 ,胆汁外漏 3例 ,胆汁瘤 1例 ,经治疗后症状消失。结论　微创法PTBD具有独到优点 ,疗效可靠 ,单纯外引流和内外引流术具有同样减轻黄疸效果 ,临床工作中应根据梗阻部位和 Objective To investigate the effective method of percutaneous transhepatic biliary drainage (PTBD) in the treatment of malignant obstructive jaundice. Materials and Methods All of the 145 patients with malignant obstructive jaundice were treated with minimally invasive PTBD. All patients were diagnosed as malignant obstructive jaundice by imaging, biochemical examination with CT, MRI or B ultrasound. 88 males and 57 females with an average age of 5 8.3 ± 11.7 years. PTBD puncture success rate was 100%. Thirty-one patients underwent punctured the right hepatic duct under TV fluoroscopy, including 125 cases of right anterior branch and 6 cases of right posterior branch. Twenty-four patients underwent B-guided transhepatic hepatic duct (including 12 cases of left hepatic duct and 2 cases of right posterior branch of liver tube). Results Eighty-eight patients underwent right and left internal and external drainage. Among them, 41 patients underwent simple external drainage (39 patients received right external drainage and 2 patients received left external drainage) and 8 patients received combined external and internal drainage of the right branch and external drainage of the left branch. Routine left branch internal and external drainage; external drainage of 35 patients after 1 to 2 weeks of external drainage, and then successfully converted to internal and external drainage. The other 6 cases continued with drainage outside the tube. Compared with preoperative serum total bilirubin (P <0.05), the systemic condition improved and the serum alanine aminotransferase decreased significantly (P <0.05). The external drainage group was better than the internal and external drainage group Preoperative and postoperative bilirubin reduction in the drainage group was also significant (P <0.05), and the two groups were comparable before surgery (P> 0.05). Complication rate was 6.9%, including 6 cases of biliary tract infection, 3 cases of bile leakage, 1 case of bile tumor, the symptoms disappeared after treatment. Conclusion minimally invasive PTBD has unique advantages, reliable curative effect, simple external drainage and internal and external drainage have the same effect of reducing jaundice, clinical work should be based on the site of obstruction and