经皮肝穿刺胆道支架植入后再狭窄分析及介入治疗  

The Cause and Treatment of Restenosis after Percutaneous Transhepatic Biliary Stent Placement

作　　者：孙华[1] 董永安[1] 李东辉[1] 季芳英[1] 吴文中[1] 

机构地区：[1]陕西省人民医院介入放射科,陕西西安710068

出　　处：《实用放射学杂志》2007年第8期1093-1095,共3页Journal of Practical Radiology

摘　　要：目的探讨恶性胆道梗阻性黄疸经皮肝穿刺胆道支架置放术后支架再狭窄原因及介入治疗。方法20例胆道支架再狭窄患者，根据术后引流量及黄疸消退情况，于2周，1个月，2个月，3个月复查肝功、血、尿、粪及B超、CT、经引流管胆道造影，确认支架再狭窄性质、部位后，利用外置引流管途径行介入再通治疗。支架均为国产普通镍钛合金胆道支架，直径10mm，长度40-80mm。结果20例支架再狭窄中，9例为肿瘤浸润压迫所致，3例为支架上端成角致阻塞，4例为胆泥及食物残渣或陈旧性凝血块阻塞支架，2例为胆管炎性狭窄，2例为肉芽组织增生引起阻塞。全部再狭窄病例经引流管抽吸、药物灌注、冲洗、导管导丝疏通、球囊扩张、支架再植入予以复通，生存期超过6个月。结论经皮肝穿刺胆道支架植入术治疗恶性胆道梗阻，术后支架再狭窄率仍较高，应引起重视。Objective To explore the cause and the interventional treatment of restenosis after percutaneous transhepatic biliary stent. Methods 20 patients with biliary restenosis after percutaneous transhepatic biliary stent placement were collected. According to drainage volume from biliary tract and degree of amelioration of jaundice,post - operation hepatic function, blood, urine and stool routines, ultrasound, CT scan and cholanglography were performed to determine the nature and location of biliary restenosis, and then all cases underwent recanalization with intervention method by the exteriorized drainage tube approach. The China - made nickel - titanium alloy stents with diameter of 10 mm and length ranged from 40 mm to 80 mm were used. Results The billary restenosis occurred in mid - inferior segment of common bile duct in 9 patients, common hepatic duct in 7 patients and hepatic porta in 4 patients. As regarding the causes of restenosis included tumor compression in 9 cases, angulation in upper segment of stent in 3 cases, obstruction in stent by bile, food or clot in 4 cases, cholangitic stenosis in 2 cases and granulation proliferation in 2 cases. The obstruction in all cases was relived by extraction through drainage tube, drug irrigation,dredging by wire, balloon dialtion or stent replacement, so that the total survival rate was beyond 6 months. Conclusion After percutaneous transhepatic biliary stent placement in treating the malignant biliary obstruction, the rate of biliary restenosis is still high, which should be attached importance to.

关 键 词：胆道 恶性梗阻 支架术后再狭窄 介入放射学 

分 类 号：R575.7[医药卫生—消化系统] R815[医药卫生—内科学]