再次经皮经肝胆道支架置入治疗恶性梗阻性黄疸  

Re-implantation of Biliary Metal Stents Through Percutaneous Transhepatic Cholangial Drainage for Malignant Obstructive Jaundice

作　　者：金浩[1] 刘会春[1] 李宗狂[1] 王勇[1] 鲁贻民[1] 周磊[1] 潘洪涛[1] 黄伟[1] 

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,蚌埠233004

出　　处：《中国微创外科杂志》2017年第11期986-989,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：安徽省科技攻关基金项目(编号:1501041155);蚌埠医学院科技发展基金项目(编号:BYKF1404)

摘　　要：目的探讨再次经皮经肝置入胆道金属支架治疗恶性梗阻性黄疸的可行性和疗效。方法 2012年6月~2016年3月,33例恶性梗阻性黄疸经皮经肝胆道支架置入术后再次出现梗阻性黄疸,在数字减影血管造影(DSA)下经皮经肝置入胆道金属支架,回顾性分析其临床资料。结果 31例成功再次置入支架,术后1周、1个月和3个月血丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)下降。截至2016年5月,支架梗阻10例(生存3例,死亡7例),支架通畅时间1~9个月,中位数7个月;支架通畅21例(生存8例,死亡13例),随访1~20个月,中位数6个月。生存11例,随访1~20个月,中位数8个月;死亡20例,生存1~11个月,中位数7个月。结论对于经皮经肝胆道支架置入术后再次出现梗阻性黄疸者,再次行胆道支架置入术可一定程度延长生存期,改善生活质量。Objective To explore the feasibility and efficacy of re-implantation of biliary metal stents through percutaneous transhepatic cholangial drainage for treating malignant obstructive jaundice. Methods From June 2012 to March 2016,33 cases of malignant biliary obstruction suffered a relapse of obstructive jaundice after implantation of biliary metal stents through percutaneous transhepatic cholangial drainage,and then a re-implantation of stents under digital subtraction angiography（DSA） was performed.Their clinical data were retrospectively analyzed. Results The re-implantation of biliary metal stents was successfully completed in31 cases,with decreased alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TBIL）,and direct bilirubin（DBIL） at 1 week,1 month,and 3 months after surgery. Until March 2016,the stents were obstructed in 10 cases（including 3 alive cases and 7 dead cases） with a patency time of 1-9 months（median,7 months）. The stents were unobstructed in21 cases（including 8 alive cases and 13 dead cases） with follow-ups for 1-20 months（median,6 months）. There were 11 alive cases who had been followed up for 1-20 months（median,8 months） and 20 dead cases with a survival time of 1-11 months（median,7 months）. Conclusion For patients with re-emerged obstructive jaundice after implantation of biliary metal stents through percutaneous transhepatic cholangial drainage,a re-implantation of biliary metal stents can extent their life time to a certain extent and improve their life quality.

关 键 词：恶性胆道梗阻 经皮经肝胆道引流 胆道支架 二次手术 

分 类 号：R730.5[医药卫生—肿瘤]