介入治疗T管引流术后胆道再狭窄的初步探讨  

Interventional therapy for biliary restenosis occurring after surgical T-tube drainage : preliminary investigation

作　　者：李臻[1] 石冰涛[2] 李娅[3] 李鑫[1] 王家祥[4] 韩新巍[1] 

机构地区：[1]郑州大学第一附属医院放射介入科,450052 [2]河南医学高等专科学校基础医学部 [3]郑州大学第一附属医院消化内科 [4]郑州大学第一附属医院外科

出　　处：《介入放射学杂志》2017年第8期739-743,共5页Journal of Interventional Radiology

摘　　要：目的评价介入治疗外科T管引流后胆道再狭窄的疗效、安全性、可行性。方法回顾性分析2014年6月—2016年3月收治的T管术后胆道再狭窄的25例患者资料,其中胆管癌6例,胆囊癌3例,胆系结石13例,肝癌2例,胃癌外科术后1例。25例中合并胰胆管合流异常4例。经原T管途径行介入治疗22例,经T管造影后再行PTCD治疗3例。所有患者中,行球囊扩张配合胆道引流者21例,行胆道金属支架植入者4例。良性狭窄患者引流管保留2~3个月后给予拔除。患者经门诊或电话随访3~24个月,通过引流管造影评价疗效。结果介入手术均顺利,无相关并发症发生,技术成功率100%。15例良性胆道狭窄患者经原T管窦道途径行球囊扩张成形术,留置胆道10.2~12 F内外引流管,拔除原T管。随访发现1例胆管癌吻合口狭窄患者术后8个月死于肺部感染。10例恶性狭窄中,3例胆道梗阻位于T管上方,均行PTCD术;其中2例肝癌侵犯胆道患者,癌栓范围较大,行内外引流管植入;黄疸消退后分别于术后1个月、2.2个月死于肝衰竭;1例胆囊癌侵犯胆道行支架植入,术后2.5个月死于肿瘤进展。7例胆道梗阻位于T管下方,经T管窦道途径植入内外引流管4例,植入金属支架3例。其中2例胆囊癌患者分别于术后3.8个月、5个月死于肿瘤进展;5例胆管癌患者中2例术后3个月出现支架再狭窄,给予PTCD处理。3例于术后3.6个月、5.2个月、9个月死于肿瘤进展、多脏器功能衰竭。结论介入治疗外科T管引流后胆道再狭窄疗效确切,安全可行,可明显改善患者生活质量。Objective To evaluate the curative effect, safety and feasibility of interventional therapy for biliary restenosis occurring after surgical T-tube drainage. Methods The clinical data of 25 patients with biliary restenosis that occurred after surgical T-tube drainage, who were admitted to authors＇ hospital during the period from June 2014 to March 2016, were retrospectively analyzed. The primary diseases included bile duct carcinoma （n=6）, gallbladder carcinoma （n=3）, biliary stone （n= 13）, hepatocellular carcinoma （n=2） and gastric cancer after surgery （n=l）. Abnormal junction of pancreatic duct and biliary duct was observed in 4 patients. Interventional procedure via T-tube route was carried out in 22 patients, and T-tube radiography with subsequent percutaneous transhepatic cholangial drainage （PTCD） was conducted in 3 patients. Biliary balloon expansion combined with biliary drainage was performed in 21 patients, and biliary metal stent implantation was adopted in 4 patients. For patients with benign biliary stricture, the drainage tube was retained for 2-3 months before it was removed. All the patients were followed up for 3-24 months at outpatient clinic or by the telephone. The curative effect was evaluated with drainage-tube radiography. Results The interventional operation was successfully accomplished in all patients, no procedure-related complications occurred, the technical success rate was 100%. In 15 patients with benign biliary stricture, biliary plasty with balloon expansion via the T-tube fistula was conducted, then a 10.2-12 F drainage catheter was placed in the biliary tract and the T-tube was pulled out. During the follow-up period, one patient with anastomotic stricture of bile duct carcinmna died of pulmonary infection at 8 months after treatment. Of the 10 patients with malignant stricture, the biliary obstrnction was located above the T-tube level in 3, and all the 3 patients received PTCD. Among the 3 patients, 2 patients had hepatocellular carcinoma complicated b

关 键 词：阻塞性黄疸 T管 介入治疗 支架 球囊扩张成型术 

分 类 号：R657.4[医药卫生—外科学]