内镜下胆道金属支架治疗肝门部胆管恶性梗阻的临床研究  

Effects of biliary metal stents for malignant hilar biliary obstruction

作　　者：王祥[1] 于忆[1] 黄晓俊[1] 刘子燕[1] 樊红[1] 冯彦虎[1] 马力[1] 

机构地区：[1]兰州大学第二医院消化内科,甘肃兰州730000

出　　处：《中华肿瘤防治杂志》2009年第17期1346-1348,共3页Chinese Journal of Cancer Prevention and Treatment

摘　　要：为了探讨经内镜放置胆道金属支架治疗肝门部胆管恶性梗阻的可行性及安全性,回顾分析我院接受胆道金属支架治疗的67例肝门部恶性梗阻患者临床资料。所有患者术前行B超、CT、MRCP或ERCP检查。常规ERCP检查,置入导丝越过狭窄段,经胆道扩张管扩张后,在X线监视下置入胆道金属支架,支架近端超过狭窄1.5cm。67例患者中置入支架62例,成功率91.9%,术后出现胆道感染15例,全部经抗感染治疗后控制。放置支架1周后血清胆红素由术前(349.32±62.39)μmol/L降至(67.43±12.56)μmol/L,平均通畅时间145d。对其中支架堵塞后的26例患者,再次行内镜检查及治疗,分别置入塑料支架8例,放置鼻胆引流管11例,治疗失败7例。初步研究结果提示,胆道金属支架置入对难以手术切除的肝门部胆管恶性梗阻有较明显治疗效果,是一种操作简单、经济有效、并发症少的方法,具有安全性和可行性。The objective of this study was to evaluate the feasibility and safety of biliary metal stent via endoscopic in the treatment of malignant hilar biliary obstruction. Clinical data of 67 patients with malignant obstructive jaundice due to hilar cholangiocarcinoma undergoing biliary metal stent were retrospectively analyzed. All the patients with B ultrasound, CT, MRCP or ERCP examinations before operation were examined by conventional ERCP, then the guide wire was success/ally inserted into the biliary duct, acrossing the narrow, expanded by the bile expansion pipe, and the stent was pushed to the properly site and surpassing 1.5 cm of the obstructive site in the X-ray monitor. The success rate was 91.9 percent under 62 cases of stenting. Postoperative 15 cases occurred biliary tract infections and were controlled by the anti-inflammatory. The level of total serum bilirubin decreased from （349.32± 62.39） μmol/L to （67.43±12.56） μmol/L after the stent placemented a week. The average duration time was 145 days. Twenty-six patients with hiliary stent blocked again, were reendoscopic examination and re treatment, and plastic stents were placed in 8 cases, ENBD in 11 cases, and failed in 7 cases （all ＂the patients with type Bismuth Ⅳ）. In conclusion, endoscopic metal biliary stent placement has a significant effect on hepatic haulm biliary carcinoma which is difficult for surgical resection, and the measure is simple and cost-effective, and has less complications,with safety and feasibility.

关 键 词：回顾性研究 内窥镜检查 消化系统 胆管肿瘤/外科学 支架 

分 类 号：R735[医药卫生—肿瘤]