胃癌术后阻塞性黄疸钳夹活检病理学及介入治疗疗效研究  

The research of cholangiobiopsy with forceps biopsy and interventional treatment for obstructive jaundice caused by gastric cancer postoperation

作　　者：张伟[1] 韩新巍[2] 李臻[2] 

机构地区：[1]河南省郑州市第一人民医院介入科,河南郑州450004 [2]郑州大学第一附属医院介入治疗中心,河南郑州450052

出　　处：《医学影像学杂志》2013年第2期252-254,258,共4页Journal of Medical Imaging

摘　　要：目的探讨胃癌术后阻塞性黄疸钳夹活检病理学及介入治疗的疗效。方法分析21例胃癌术后阻塞性黄疸患者的临床资料,右侧腋中线经皮经肝穿刺入路20例,剑突下左侧胆道穿刺入路1例,21例患者均成功施行了胆道引流术,其中18例打通胆道阻塞段后施行了胆道钳夹活检,介入术前1天血清胆红素与术后3天、1周、2周胆红素水平进行重复测量数据的方差分析。结果 18例胆道钳夹活检病理学诊断为高分化腺癌3例,中分化腺癌2例,低分化腺癌8例,慢性炎症并纤维组织增生5例;引流术前血清胆红素与术后3天、1周、2周胆红素水平比较有统计学意义(P<0.05),术后显著下降。结论胃癌术后阻塞性黄疸患者钳夹活检病理学对患者的病情、预后判断及后期治疗提供了依据;经皮经肝穿刺胆道引流术疗效显著,可显著缓解黄疸,改善肝功能,延长患者生存时间。Objective To explore the pathology of cholangiobiopsy with forceps biopsy and the effect of interventional treatment for obstructive jaundice caused by gastric cancer postoperation. Methods 21 patients with obstructive jaundice caused by gastric cancer postoperation was reviewed. Percutaneous transhepatic biliary drainage （PTCD） was performed with right approach in 20 and left approach in 1. All 21 were performed PTCD successfully and 18 performed cholangiobi opsy with forceps biopsy. We analyzed the serum bilirubin of different stage with analysis of variance of repeated measure ment data, including preoperative 1 day, postoperative 3 days, 1 week, 2 weeks. Results High differentiated adenocarci- noma was found in 3 cases, and Moderately in 2, poorly in 8, chronic inflammation with fibrous hyperplasia in 5. The ser- um bilirubin was descended significantly after interventional therapy （ P d0.05） compared preoperative 1 day with postop- erative 3 days, 1 week, 2 weeks. Conclusion The cholangiobiopsy with forceps biopsy was helpful to estimate state of ill- ness, prognosis and follow up therapy. PTCD is an effective and safe palliative therapy for obstructive jaundice caused by recurrent gastric cancer postoperation, it can alleviate jaundice and improve the liver function with longer survival rate.

关 键 词：胃癌 胆管阻塞 胆道活检 介入放射学 

分 类 号：R735.2[医药卫生—肿瘤] R735.8[医药卫生—临床医学]