经皮经肝胆道引流术联合胆道球囊扩张术治疗良性胆肠吻合口狭窄  

Percutaneous transhepatic biliary drainage combined with balloon dilatation in treatment of benign biliary-enteric anastomotic strictures

作　　者：周传国[1] 魏宝杰[1] 王剑锋[1] 翟仁友[1] 高堃[1] 

机构地区：[1]首都医科大学附属北京朝阳医院介入医学科,北京100020

出　　处：《中国介入影像与治疗学》2016年第9期521-525,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的 评估经皮经肝胆道引流术联合胆道球囊扩张术治疗良性胆肠吻合口狭窄的有效性及安全性。方法 回顾性分析经皮经肝胆道引流术联合胆道球囊扩张术治疗的良性胆肠吻合口狭窄患者14例,记录手术成功率、引流管拔除率、手术相关并发症,并随访胆肠吻合口长期开通情况。结果 对所有患者均一次性成功实施经皮经肝胆道引流术,手术成功率100%（14/14）,行胆道球囊扩张术1~6次,平均（3.0±1.8）次,胆道球囊直径8~10mm,单次球囊扩张时间1~3min。引流管拔除率85.71%（12/14）,可夹闭引流管、但需间断开放引流管者占14.29%（2/14）。14例患者术后总胆红素、直接胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、γ-谷胺酰转肽酶较术前均明显下降（P均〈0.05）。所有患者术中、术后生命体征平稳,1例患者因术中疼痛需静脉麻醉处理。随访6~54个月,中位随访时间17.5个月,吻合口开放良好。结论 经皮经肝胆道引流术联合胆道球囊扩张术处理良性胆肠吻合口狭窄临床效果好,患者耐受性良好,手术并发症少。Objective To evaluate the effectiveness and safety of percutaneous transhepatic biliary drainage combined with biliary balloon dilatation in the treatment of benign biliary-enteric anastomotie stenosis. Methods Totally 14 cases of be- nign biliary-enteric anastomotic stenosis treated by percutaneous biliary drainage combined with biliary balloon dilatation were analyzed retrospectively. The success rate of the procedure, the rate of drainage tube removal, and the procedure re- lated complications and follow up the opening of the biliary-enteric anastomosis were recorded. Results Percutaneous tran- shepatic biliary drainage was successfully performed in all patients. The success rate of procedure was 100% （14/14）. The cycles of balloon angioplasty were 1--6 times, with the average times 3.0±1.8. The diameter of the balloon was 8-- 10 mm. The average time of dilatation was 1--3 rain in one cycle. The biliary drainage tube removal rate was 85.71% （12/ 14）. The cases which could clamp the biliary drainage tube, but need to discontinuous open biliary drainage account for 14.29 % （2/14）. Postoperative total bilirubin, direct bilirubin, alanine amino transferase, aspartate amino transferase, al- kaline phosphatase, gamma-glutamyl transferase level decreased significantly in all 14 patients （all P〈0.05）. The vital signs of all patients were stable in perioperative period. Only 1 case need intravenous anesthesia due to pain during opera- tion. All patients were followed up for 6--54 months （median follow-up time 17.5 months）. The biliary enteric anastomo- sis opens well. Conclusion Percutaneous transhepatic biliary drainage combined with biliary balloon dilatation in the treat- ment of benign biliary-enteric anastomotic stenosis result in good clinical outcome, with well tolerated and less post-proce- dure complications.

关 键 词：胆肠吻合口狭窄 经皮经肝胆道引流术 胆道球囊扩张术 

分 类 号：R657.4[医药卫生—外科学]