经皮肝穿刺胆道引流术联合胆道内支架治疗高位胆道恶性梗阻12例  

The effect of percutaneous transhepatic biliary drainage combined with biliary stent in the treatment of malignant upper biliary tract obstruction in 12 cases

作　　者：徐万里[1] 金涛[1] 江谋应 王金林[1] 冯晶晶[1] 陈明朗[1] 

机构地区：[1]安徽省安庆市第一人民医院放射科,246003

出　　处：《蚌埠医学院学报》2013年第9期1123-1126,共4页Journal of Bengbu Medical College

摘　　要：目的:探讨经皮肝穿刺胆道引流术(PTBD)联合胆道内支架治疗高位恶性胆道梗阻的疗效。方法:12例患者分别行单侧/双侧穿刺入路,置入支架。其中肝总管内置入单枚支架7例;双侧肝管穿刺,行左肝和右肝胆管同时置入支架3例;采用单侧肝管穿刺入路,于左-右肝管间和肝管-胆总管间均置入支架2例。结果:12例手术均成功,术后患者黄疸明显减轻或消退,术后7 d总胆红素、直接胆红素以及碱性磷酸酶、丙氨酸氨基转移酶和γ-谷氨酰转移酶水平均较治疗前明显降低(P<0.01),其中1例分别于术后4个月发生支架内梗阻,行二次介入治疗,1例于胆道支架置入术后6个月发生十二指肠梗阻,再行十二指肠支架置入术。结论:根据不同梗阻部位,采取不同胆道支架置入技术治疗高位胆道恶性梗阻是一种安全可靠、疗效确切的姑息性疗法。Objective：To explore the effects of percutaneous transhepatic biliary drainage（PTBD） combined with biliary stent in the treatment of malignant upper biliary tract obstruction. Methods： Stents were implanted into 12 patients by unilateral or bilateral puncture. The single stent was implanted into the ductuli hepaticus communis in 7 cases. The stents were implanted into the left and right hepatic duct through bilateral hepatic duct puncture in 3 cases at the same time. The stents were implanted into between the 1 eft and right hepatic duct and between the hepatic duct and the common bile duct through unibilateral hepatic duct puncture in 2 cases. Results ：Twelve operations were successful. The jaundice of all patients alleviated or disappeared obviously after implantation. After 7 d total bilirubin, direct bilirubin, alkaline phosphatase, alanine aminotransferase, ^-glutamine transaminase levels before treatment difference was statistically significant（P 〈 0.05 - P 〈 0.01 ）. One case with stent obstruction was found in 4 months after operation, who were treated with secondary intervention. One case with duodenal obstruction was found in 6 months after implanting sent into biliary tract, who was treated with stent in duodenum. Conclusions：Implanting stent into different bile duct for treating malignant upper biliary tract obstruction is safe, reliable and good effects.

关 键 词：胆汁瘀积 恶性梗阻性黄疸 介入治疗 胆道支架 

分 类 号：R575[医药卫生—消化系统]