摘要
目的：探讨跨越Vater壶腹胆道支架置入术治疗恶性胆道低位梗阻的安全性，有效性。方法：32例恶性胆道低位梗阻患者（男26例，女6例，平均年龄56.6岁），术前经CT和MRCP证实为恶性胆道低位梗阻。其中，胰头癌12例，胃癌术后淋巴结转移5例，膀胱癌淋巴结转移1例，壶腹周围癌6例，胆总管癌7例，十二指肠乳头癌1例。32例患者行经皮经肝胆道穿刺（右侧腹壁穿刺28例，剑突下穿刺4例），于胆总管末端跨越Vater置入32枚自膨式胆道支架。结果：32例患者手术成功率100%，支架位置良好，胆汁通畅。术中无胆道出血，无胆汁渗漏及胆管破裂。术后总胆红素由（205.7±16.2）mg/dl降为（35.5±6.7）mg/dl。术后12小时发生急性胰腺炎1例，对症治疗后出院。术后30天内发生胆系感染2例，抗炎治疗好转后出院。随访1~26个月（平均15.4个月），6例再发支架内梗阻（其中5例再行支架治疗或引流治疗，1例未治疗死亡），2例出现十二指肠梗阻，行十二指肠支架治疗后缓解。6例由于肿瘤转移非黄疸性死亡。结论：跨越Vater壶腹胆道支架置入术是治疗恶性低位胆道梗阻的安全、有效的方法。
Abstract
Objective: To evaluate the efficacy of transhepatic crossed papillary biliary metallic stent placement in malignant extrahepatic biliary strictures. Methods: Thirty-two patients of malignant extrahepatic biliary strictures confirmed by CT and MRCP, including 26 men and 6 women, the average age was 56.6 years. Among the 32 patients, 12 cases were of carcinoma of head of pancreas, 5 cases of carcinoma of stomach lymphonode metastasis, 1 case of carcinoma of bladder lymphonode metastasis, 6 cases of periampullary carcinoma, 7 cases of common bile duct carcinoma, 1 case of duodenal papilla carcinoma. Thirty-two patients were treated with percutaneous transhepatic cholangiography(PTC), and 32 biliary metallic stents were implanted by crossed papillary methods. Results: The success rate was 100%, with bile ducts patency. There were no hemobilia, leakage, and rupture of bile tract. The TBIL(total bilirubin) dropped from (205.7±16.2)mg/dl to (35.5±6.7)mg/dl after operation. One case of acute pancreatitis, 2 cases of biliary tract infection were encountered 12hrs and 30 days after the procedure respectively, and these patients were discharged after symptomatic treatment. The follow-up periods were 1~26 months(average 15.4 months), 6 patients had biliary tract in stent(5 patients were treated with percutaneous tranhepatic drainage or stent implantation, 1 patient died), 6 patients died because of carcinoma metastasis, 2 patients had duodenal ileus. Conclusion: The crossed papillary transhepatic biliary metallic stent placement in malignant extrahepatic biliary is a safe and effective method.
关键词
胆汁淤积 /
肝胰管壶腹 /
支架
Key words
Cholestasis /
Ampulla of Vater /
Stents
冯 博;石 强;徐 克;苏红英;黄 昆;梁松年;张曦彤;肖 亮.
跨越Vater壶腹胆道支架置入术治疗恶性低位胆道梗阻（附32例报告）[J]. 中国临床医学影像杂志. 2008, 19(4): 265-268
FENG Bo;SHI Qiang;XU Ke;SU Hong-ying;HUANG Kun;LIANG Song-nian;ZHANG Xi-tong;XIAO Liang.
Study on transhepatic crossed papillary biliary metallic stent placement in malignant biliary strictures(analysis of 32 cases)[J]. Journal of China Clinic Medical Imaging. 2008, 19(4): 265-268
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