经PTC或ERC两种途径放置胆道支架治疗恶性胆管梗阻对比分析  

The Compare and Analysis of Biliary Tract Stent Placing for Malignant Obstruction of Biliary Tract by Percutaneous Transhepatic Cholangiography or Endoscopic Retrograde Cholangiography

作　　者：闫勇[1] 戴睿武[1] 汪涛[1] 叶明辉[1] 张生[1] 江宗兴[1] 

机构地区：[1]成都军区总医院普通外科,四川成都610083

出　　处：《中国普外基础与临床杂志》2011年第11期1184-1187,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较经PTC或ERC两种途径放置胆道支架治疗恶性胆管梗阻的疗效。方法 PTC途径:在超声引导下选择胆管走行与胆总管夹角较大、扩张的左右肝内胆管,穿刺置管引流,1周后再置入支架,共68例(其中有2例系ERC途径失败者)。ERC途径:在十二指肠镜下逆行插入引流管于胆总管内,经造影显示梗阻部位,其引导丝通过梗阻部位,然后沿引导丝置入支架,共53例。结果 经PTC或ERC途径放置支架成功率分别为100%(68/68)和96.2%(51/53),2组均未发生出血及漏胆并发症。全部患者获随访1～18个月(平均12.4个月),结果PTC组和ERC组放置支架后6个月内死亡者分别为7和5例,18个月仍存活者分别为17和9例。结论对失去手术机会或不能耐受手术的恶性胆管梗阻患者采取支架置入是有效解除梗阻、延长生存时间和提高生存质量的最佳方法。位于胆总管下端和壶腹部的梗阻首选ERC途径放置支架;位于肝门部及以上的梗阻应以PTC途径放置支架为宜。Objective To compare the therapeutic efficacy of biliary tract stent placing for malignant obstruction of biliary tract by percutaneous transhepatic cholangiography（PTC） or endoscopic retrograde cholangiography（ERC）.Methods PTC approach： choosing the expansion intrahepatic bile duct which had a large angle traveling with common bile duct at the ultrasound-guided,we performed bile duct puncture and inserted the drainage pipe into it,then stent was placed with 68 cases （2 cases among the total were failure of ERC approach） after a week drainage. ERC approach： inserting drainage tube into the common bile duct by duodenal endoscopic retrogradely, the angiography showed obstruction site,the guide wire inserted through the obstruction site,then stent was placed along the guide wire with 53 cases.Results The achievement ratio of stent placing by PTC was 100%（68/68）, and which by ERC was 96.2%（51/53）.The complications （bleeding, bile leakage） didn＇t happen in two groups.1-18 months（average 12.4 months） of follow-up,the died cases of PTC group and ERC group were 7 and 5 cases within 6 months,respectively;the survive cases of which were 17 and 9 cases after 18 months of treatment,respectively.Conclusions The biliary tract stent placing is a safe and effective method to the malignant obstruction of biliary tract patients who can not drainage tube be treated by operation.It can relieve biliary obstruction efficiency,and can increase live time and life quality for patients.We can choose the stent placing method by ERC for cases whose obstruction site is at the inferior of common bile duct or duodenal ampulla,and the cases whose obstruction site is at the above of hepatic porta should be chosen by PTC.

关 键 词：恶性胆管梗阻 经皮经肝胆管引流 内镜逆行肝胆管造影 胆道支架 

分 类 号：R735[医药卫生—肿瘤]