恶性梗阻性黄疸介入治疗并发症分析及其防治的探讨  

Prevention and Treatment of Complications during Interventional Procedure in Malignant Biliary Obstruction

作　　者：李智岗[1] 李顺宗[1] 黄景香[1] 赵俊京[1] 韩捧银[1] 杨光[1] 梁国庆[1] 王红光[1] 

机构地区：[1]河北医科大学第四医院放射科,河北石家庄050011

出　　处：《实用放射学杂志》2007年第10期1371-1374,共4页Journal of Practical Radiology

基　　金：河北省普通高校强势特色学科肿瘤学科研究资助项目

摘　　要：目的探讨经皮经肝胆管引流和置入内支架治疗恶性梗阻性黄疸的方法及并发症的预防。方法65例恶性梗阻性黄疸患者接受经皮经肝胆管引流和置入内支架治疗。其中肝门部肝癌18例,胆管癌16例,胆囊癌累及胆总管3例,胃癌肝门淋巴结转移16例,胰腺癌8例,胆肠吻合术后吻合口狭窄4例。结果20例放置了胆管支架,其中2例因左右肝总管梗阻各放置了2枚金属内支架;15例放置了内外引流管;29例单纯放置外引流管;1例右侧胆管放置支架,左侧放置内外引流管。与操作有关的并发症为胆管出血2例,其中胆管出血致出血性休克1例;感染4例,2例出现败血症;肝功能损害5例;局限胆汁性腹膜炎并发反应性胸腔积液1例;电解质紊乱1例;引流管部分移位或脱出8例;引流管阻塞2例;支架置入后早期发生再狭窄1例。结论恶性梗阻性黄疸介入治疗方法简单、疗效确切,正确选择适应证、规范操作技术可以减少并发症的发生。Objective To study the techniques and complications of percutaneous transhepatic biliary drainage （PTBD） and stent implantation for the treatment of malignant biliary obstruction. Methods Pereutaneous stent implantation and external/internal external catheter drainge were adopted in 65 patients with malignant biliary obstruction caused by hilar hepatic carcinoma（ n = 18 ） , biliary duct areinoma（ n = 16 ） wgallb ladder carcinoma with stenosis of common biliary duct （n = 3 ） , stomach carcinoma metastasis to hepatic hilum （n = 16 ） , pancreatic eareimoma（ n = 8 ） , stricture at anastomotie site postoperation of biliary duct - jejunum （ n = 4 ）. Results 20 patients received biliary stent implantation,of them,2 patients were placed 2 biliary stents in the left and the right common hepatic duct respectively; 15 patients treated with internal external drainage;29 patients externa adrainage catheter were placed simply;one patient received biliary stent implantation in right biliary duct and internal external drainage in left biliary duct . Complications included hemobilia （ n = 2 ） ,including one case of shock caused by heamobilia , infection （ n = 4 ） , septicemia （ n = 2 ） , hepatic function damage （ n = 5 ） ,local peritonitis with pleural effusion （ n = 1 ） , disorder of electrolyte（ n = 1 ） , displace of catheter（ n = 8 ） ,obstruction of catheter（ n = 2 ） and biliary duct stenosis after implantation of stent within 2 months （ n = 1 ）. Conclusion The pereutaneous transhepatie biliary drainage and stent implantation are simple,effective method in treating the malignant biliary obstruction. Choosing adapted patients and regulating procedure can decrease the complications.

关 键 词：胆管引流 胆管梗阻 介入放射学 并发症 

分 类 号：R575[医药卫生—消化系统] R815[医药卫生—内科学]