目的 探讨经皮经肝穿刺胆道引流术(PTCD)联合胆道支架置入术治疗恶性梗阻性黄疸的操作技巧及其临床应用价值。
方法 2009年8月至2011年5月期间中国医科大学附属第四医院介入科对39例恶性梗阻性黄疸患者施行了PTCD联合胆道支架置入术,对其临床资料和效果进行回顾性分析。
结果 39例患者全部穿刺成功,穿刺成功率为100%。穿刺左叶胆管11例,穿刺右叶胆管19例,左右胆管均行穿刺9例;单纯外引流22例,内外引流17例;引流管保留7~14d后均成功行胆道支架置入术。 33例患者自觉症状有缓解。患者术后14d时,其白蛋白、碱性磷酸酶、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素水平均较术前降低(P<0.05)。术后发生胆道感染3例(7.69%),发生急性胰腺炎4例(10.26%),发生支架脱落移位1例(2.56%),无胆汁性腹膜炎等并发症发生。本组32例患者获访,随访时间为8d~16.5个月,平均9.4个月。随访期间,27例患者死于肿瘤进展及多脏器功能衰竭;5例患者存活,无黄疸加重症状。
结论 PTCD联合胆道支架置入术是一种姑息治疗恶性梗阻性黄疸的有效方法,具有简便、有效、安全、可重复性等优点,但需注意其适应证的选择和并发症的预防。
Citation:
王刚,钟红姗,王洪新,王宝明. Effect of Percutaneous Transhepatic Cholangio-Drainage Combined with Biliary Stent for Malignant Obstructive Jaundice in 39 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(12): 1417-1420. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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邹晓平, 湛先保, 李兆申, 等. 胆管内外引流治疗内镜难治性恶性胆道梗阻的对比研究[J]. 中华内科杂志, 2004, 43(2):109-111.
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湛先保, 李兆申, 邹多武, 等. 经皮经肝胆管内外引流术治疗恶性胆道梗阻的疗效观察[J]. 中华消化内镜杂志, 2006, 23(6):410-412.
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郭元星, 李彦豪, 陈勇, 等. 金属支架、内涵管治疗恶性胆管梗阻的临床疗效比较[J]. 临床放射学杂志, 2003, 22(9):783-785.
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Boulay BR, Gardner TB, Gordon SR. Occlusion rate and comp-lications of plastic biliary stent placement in patients undergoing neoadjuvant chemoradiotherapy for pancreatic cancer with malignant biliary obstruction[J]. J Clin Gastroenterol, 2010, 44(6):452-455.
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Wilcox CM, Phadnis M, Varadarajulu S. Biliary stent placementis associated with post-ERCP pancreatitis[J]. Gastrointest Endosc,2010, 72(3):546-550.
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Rieber A, Brambs HJ. Metallic stents in malignant biliary obstru-ction[J]. Cardiovasc Intervent Radiol, 1997, 20(1):43-49.
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郭启勇, 卢再鸣, 刘兆玉, 等. 金属内支架和局部治疗相结合治疗肝门部胆管癌[J]. 中华放射学杂志, 1997, 5(5):16-19.
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周君, 李玉东. 经皮肝穿刺胆管内支架置入联合动脉化疗治疗恶性阻塞性黄疸18例[J]. 中原医刊, 2004, 31(14):38-39.
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- 1. 邹晓平, 湛先保, 李兆申, 等. 胆管内外引流治疗内镜难治性恶性胆道梗阻的对比研究[J]. 中华内科杂志, 2004, 43(2):109-111.
- 2. 湛先保, 李兆申, 邹多武, 等. 经皮经肝胆管内外引流术治疗恶性胆道梗阻的疗效观察[J]. 中华消化内镜杂志, 2006, 23(6):410-412.
- 3. Anderson EM, Phillips-Hughes J, Chapman R. Sigmoid colonic perforation and pelvic abscess complicating biliary stent migration[J]. Abdom Imaging, 2007, 32(3):317-319.
- 4. Shinchi H, Takao S, Nishida H, et al. Length and quality of survival following external beam radiotherapy combined withexpandable metallic stent for unresectable hilar cholangiocarcinoma[J]. J Surg Oncol, 2000, 75(2):89-94.
- 5. 郭元星, 李彦豪, 陈勇, 等. 金属支架、内涵管治疗恶性胆管梗阻的临床疗效比较[J]. 临床放射学杂志, 2003, 22(9):783-785.
- 6. 黄志强. 胆道外科手术学[M]. 济南:山东科学技术出版社, 1998:168-170.
- 7. 施海彬, 李麟荪, 徐泽宽, 等. 经皮胆道引流术治疗恶性梗阻性黄疸[J]. 介入放射学杂志, 2001, 10(5):292-295.
- 8. 谢宗贵, 张希全, 李凡东, 等. 胆道支架技术5年回顾(213例随访报告)[J]. 中华肝胆外科杂志, 2002, 8(10):595-597.
- 9. 许庆华, 刘鹏飞, 项斌, 等. 胆道金属支架治疗恶性梗阻性黄疸的预后因素分析[J]. 南京医科大学学报:自然科学版, 2009, 29(8):1185-1187.
- 10. Cameron JL, Skinner DB, Zuidema GD. Long term transhepatic intubation for hilar hepatic duct strictures[J]. Ann Surg, 1976, 183(5):488-495.
- 11. Boulay BR, Gardner TB, Gordon SR. Occlusion rate and comp-lications of plastic biliary stent placement in patients undergoing neoadjuvant chemoradiotherapy for pancreatic cancer with malignant biliary obstruction[J]. J Clin Gastroenterol, 2010, 44(6):452-455.
- 12. Wilcox CM, Phadnis M, Varadarajulu S. Biliary stent placementis associated with post-ERCP pancreatitis[J]. Gastrointest Endosc,2010, 72(3):546-550.
- 13. Roeren T, Tonn W, Richter GM, et al. Percutaneous therapy of malignant obstructive jaundice using expandable metal stents:a prospective study of 92 patients[J]. Rofo, 1996, 165(2):181-187.
- 14. Kaiho T, Miyazaki M, Ito H, et al. Treatment of unresectable hepatic hilar malignancies with self-expanding metallic stents[J].Hepatogastroenterology, 1999, 46(29):2781-2790.
- 15. Rieber A, Brambs HJ. Metallic stents in malignant biliary obstru-ction[J]. Cardiovasc Intervent Radiol, 1997, 20(1):43-49.
- 16. 郭启勇, 卢再鸣, 刘兆玉, 等. 金属内支架和局部治疗相结合治疗肝门部胆管癌[J]. 中华放射学杂志, 1997, 5(5):16-19.
- 17. 周君, 李玉东. 经皮肝穿刺胆管内支架置入联合动脉化疗治疗恶性阻塞性黄疸18例[J]. 中原医刊, 2004, 31(14):38-39.