全覆膜自膨式可回收金属支架治疗恶性梗阻性黄疸的并发症及防治策略  

Prevention and treatment of complications for full-covered self-expanding removable metal stents in malignant obstructive jaundice

作　　者：张诚[1] 杨玉龙[1] 吴萍[1] 马跃峰[1] 张洪威[1] 林美举[1] 史力军[1] 李婧伊[1] 赵沐[1] 

机构地区：[1]大连大学附属中山医院胆道微创外科,辽宁大连116001

出　　处：《中华医学杂志》2015年第6期416-419,共4页National Medical Journal of China

摘　　要：目的探讨全覆膜自膨式可回收金属支架（FCSERMS）治疗恶性梗阻性黄疸的并发症及防治策略。方法回顾性分析2012年5月至2014年3月在大连大学附属中山医院接受内镜下胆道FCSERMS置入治疗的45例恶性梗阻性黄疸患者临床资料。结果45例患者均一次性操作成功；肝功能明显改善，黄疸消退有效率91．1％（41／45），其中死亡4例。早期并发症19例，其中高淀粉酶血症8例、急性轻型胰腺炎4例、急性胆囊炎2例、胆道出血1例，经保守治疗后痊愈；发生急性化脓性胆管炎2例，急性化脓性胆囊炎2例，采取经皮肝穿刺胆道引流术（PTCD）及经皮经肝胆囊穿刺引流术（PTGBD）治疗后缓解。中晚期并发症12例，其中梗阻性黄疸3例、急性化脓性胆囊炎4例、急性胆管炎2例、肝脓肿2例、急性胰腺炎1例，采取经内镜逆行胰胆管造影（ERCP）、PTCD及PTGBD治疗后缓解。结论FCSERMS置入术后存在多种并发症，积极有效的预防及正确处理，可降低各种并发症的发生率。Objective To explore the prevention and treatment of complications for full-covered self-expanding removable metal stents （FCSERMS） in malignant obstructive jaundice. Methods The clinical data were analyzed retrospectively for 45 cases undergoing endoscopic biliary FCSERMS drainage for malignant obstructive jaundice from May 2012 to March 2014. Results Among them, 45 cases were successful one time. The parameters of liver function improved significantly with a jaundice efficiency of 91.1%. There were 4 dead cases. Among 19 cases of early complications, hyperamylasemia （ n = 8 ） , acute mild pancreatitis （ n = 4）, acute cholecystitis （ n = 2） and hemobilia （ n = 1 ） recovered after conservative treatments. Acute suppurative cholecystitis （ n = 2） and acute obstructive suppurative cholangitis （ n = 2） were cured by percutaneous transhepatic cholangial drainage （PTCD） and percutaneous transhepatic gallbladder drainage （PTGBD）. And late complications of obstructive jaundice （n = 3 ）, acute suppurative cholecystitis （ n = 4）, acute cholangitis （ n -- 2 ）, hepatophyma （ n = 2 ） and acute pancreatitis （ n = 1 ） were cured by endoscopic retrograde cholangiopancreatography （ERCP）, PTCD and PTGBD. Conclusion Various complications are associated with FCSERMS in malignant obstructive jaundice. However, positive and effective prevention and proper treatment reduce the incidence of complications.

关 键 词：可回收金属支架 内镜胆道金属支架置入 恶性梗阻性黄疸 并发症 

分 类 号：R730.5[医药卫生—肿瘤]