支架置入术在肿瘤所致门静脉及胆道狭窄中的临床应用价值  

Clinical Value of Stent Implantation in the Portal Vein and Biliary Stricture Caused by Tumor

作　　者：孙青龙 董重谋 慕义 黄锐 SUN Qing-long;DONG Zhong-mou;MU Yi(Department of Radiology,Mudanjiang Forest Center Hospital,Mudanjiang,Heilongjiang,157000,China)

机构地区：[1]牡丹江林业中心医院放射介入科,黑龙江牡丹江157000

出　　处：《黑龙江医学》2018年第10期946-948,951,共4页Heilongjiang Medical Journal

摘　　要：目的探讨经皮经肝穿门静脉支架置入术(PTPS)+经皮经肝穿胆道支架植入术(PTBS)治疗肿瘤所致门静脉高压症并梗阻性黄疸的临床应用价值。方法选择2003年8月—2017年3月共收治门静脉狭窄伴梗阻性黄疸患者36例,其中炎症性狭窄6例,肿瘤侵犯性狭窄30例,在彩超引导下分别经皮经肝穿刺门静脉和胆道成功后,实施了门静脉支架及胆道支架置入术,观察术后门静脉压力、血流速及血流量、肝功变化、临床症状、并发症及患者存活情况。术后继续给予抗炎、利尿、抗凝、保肝及对症治疗,复查血常规、凝血系列、肝功、肾功、电解质。复检腹部增强CT,观察支架情况及门静脉、胆道通畅程度。结果 36例患者成功在彩超引导DSA下行门静脉造影术+支架置入成形术,再行胆道造影术+胆道狭窄支架置入成形术,置入门静脉支架及胆道支架各48枚,门静脉压力由术前的(38. 2±5. 1) cm H_2O(1 cm H_2O=0. 098 k Pa)降至术后(17. 0±2. 1) cm H_2O,患者门静脉高压及腹水症状完全缓解,肝功明显改善,手术过程中出现穿刺部位疼痛、胆心反射、胆道出血、胆汁性腹膜炎等并发症,对症处理后症状缓解,无手术相关的严重并发症。结论支架置入术治疗肿瘤所致门静脉狭窄及胆道狭窄引起的门静脉高压及梗阻性黄疸是安全有效的,可以应用于临床诊疗。Objective To evaluate the clinical value of percutaneous transhepatic portal stent implantation （PTPS） plus percutaneous transhepatie biliarystent implantation （PTBS） for the treatment of portal hypertension caused by tumor and obstructive jaundice. Methods 36 eases from August, 2003 to March, 2017 were treated with portal vein stenosis with obstructive jaundice, including in- flamnlatory stenosis in 6 cases, tumor invasive stenosis in 30 cases. After the successful implementation of the ultrasound guided per- cutaneous transhepatie, the portal vein stent and biliary stent was done. Postoperative portal venous pressure, blood flow velocity and blood flow, liver function changes, clinical symptoms, complications and survival of patients of two groups were compared. Postopera- tive anti-inflammatory and diuretic, antieoagulation, liver and symptomatic treatment were given, and blood routine, blood coagula- tion, liver function and kidney function, electrolyte were tested. Through reviewing enhanced abdominal CT, the stent pateney of the portal vein and bile duet were observed. Results 36 eases received successful operation in the guidance of ultrasound downlink DSA portography ＋ stent insertion, and eholangiography and stenosis of biliary tract stent angioplasty were given. 48 portal vein and biliary stents were given. The portal venous pressure of preoperative period decreased from （38.2±5.1 ） cmH2O （1 cmH2O = 0. 098 kPa） to （17. 0±2.1） emH2O after operation. Portal hypertension and aseites symptoms of patients relives completely, and liver function improved. Complications of puncture pain, bile heart reflex, biliary tract bleeding, biliary peritonitis occurred during surgery relieved after treatment. There was no serious complication related with surgery. Conclusion Stent implantation is safe and effective in the treatment of portal hypertension and biliary obstruction caused by tumor and obstructive jaundice. It can be applied in clinical diagnosis and treatment.

关 键 词：肿瘤 门静脉狭窄 胆总管狭窄 门静脉高压 梗阻性黄疸 支架植入术 

分 类 号：R657.34[医药卫生—外科学]