医源性胆管损伤51例介入治疗分析  

Interventional treatment of iatrogenic bile duct injury:an analysis of 51 cases

作　　者：温锋[1] 毛晓楠[1] 卢再鸣[1] 张军[1] 单明[1] 郭启勇[1] 

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110004

出　　处：《中国实用外科杂志》2011年第7期587-590,共4页Chinese Journal of Practical Surgery

基　　金：辽宁省高校创新团队项目(2007T182)

摘　　要：目的探讨经皮介入技术在治疗医源性胆管损伤方面的价值。方法回顾性分析中国医科大学附属盛京医院2000年以来收治的先期行介入治疗的医源性胆管损伤病人51例的临床资料。结果 27例并发术区积液,行经皮腹腔积液穿刺引流术治疗,其中有6例证实为胆管瘘的病人尝试留置胆道内涵管。26例并发肝内和(或)肝外胆管扩张(包括2例术区积液病人),24例行经皮经肝胆道穿刺引流术治疗,其中3例择期行胆道球囊扩张治疗,另2例行内镜下胆道支架植入术。经皮腹腔积液穿刺引流治疗的技术成功率为100%,术后临床症状缓解率100%,影像学检查显示积液逐渐减少直至消失。4例留置胆道内涵管的病人胆管瘘即时封堵成功,2例长期留置胆道内涵管的病人胆管瘘自行愈合。经皮经肝胆道穿刺引流治疗的技术成功率100%,24例病人术后1周平均胆红素水平较术前显著下降(t=15.61,P<0.01)。3例胆道梗阻病人行胆道球囊扩张治疗均成功,术后即刻胆道均开通,1例病人在24h内出现胆道再狭窄。2例胆道梗阻病人行经内镜留置胆道支架均成功,但半年后均发生了支架再狭窄。结论经皮介入技术在医源性胆管损伤的首要对症治疗方面具有较大的应用价值。Objective To discuss the value of percutaneous interventional procedure in the treatment of iatrogenic bile duct injury. Methods The clinical data of 51 cases of iatrogenie bile duct injury treated with percutaneous interventional procedure initially since 2000 in Shengjing Hospital of China Medical University were analyzed retrospectively. Results Abdominal fluid collection was found in 27 cases and then treated with percutanous drainage initially. Biliary endoprosthesis implantation was attempted in 6 cases. Intrahepatic and/or extrahepatic bile duct dilatation was found in 26 cases. Percutaneous transhepatic biliary drainage was performed in 24 cases. Balloon dilatation was attempted in 3 cases. Endoscopic biliary stenting was performed in the other 2 cases. Percutaneous drainage Of abdominal fluid collection was performed in 27 cases successfully. The relief of clinical symptoms and the reduction of fluid collection were represented in all cases. Bile leak immediately disappeared in 4 cases performed biliary endoprosthesis implantation and the biliary fistula finally healed in 2 cases. Percutaneous transhepatic biliary drainage was all performed successfully in 24 eases. The bilirubin decreased significantly （t= 15.61, P〈O.O1） 1 week later. Balloon dilatation was performed in 3 cases successfully and the biliary obstruction was relieved immediately. However, restenosis of bile duet occurred within 24 hours in 1 ease. Endoscopic biliary stenting was performed in 2 cases successfully, who both represented restenosis of bile duet 6 months later. Conclusion Pereutaneous interventional procedure has a great value in the initial treatment of iatrogenic bile duct injury.

关 键 词：医源性胆管损伤 介入疗法 引流 球囊 

分 类 号：R6[医药卫生—外科学]