肝门部胆管癌高位多支复杂胆道梗阻的介入引流方法探讨  

Investigation of interventional draining method in complicated biliary obstruction of hilar cholangiocarcinoma

作　　者：郭俊[1] 赵文军 吕洋 杨德飞 贾广志[2] Guo Jun;Zhao Wenjun;Lyu Yang;Yang Defei;Jia Guangzhi(Department of Interventional Radiology,the Second Affiliated Hospital of Baotou Medical College,Baotou 014000,China;Department of lnterventional Radiology,the Affiliated Hospital of Inner Mongolia Medical University,Hohohot 010050,China.)

机构地区：[1]包头医学院第二附属医院介入科,包头014000 [2]内蒙古医科大学附属医院介入科,呼和浩特010050

出　　处：《中华介入放射学电子杂志》2018年第4期301-305,共5页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的:探讨肝门部胆管癌引起的高位多支复杂类型梗阻性黄疸的介入引流方法和临床疗效。方法:选取因肝门部胆管癌引起的多支复杂类型梗阻性黄疸患者38例,其中男28例,女10例。Bismuth-Corlett分型Ⅱ型6例,Ⅲ型18例,Ⅳ型14例。根据胆道梗阻的部位、范围、各分支梗阻情况及胆道扩张的程度,对不同类型患者的引流方案进行个体化设计。其中30例单纯采取了引流管引流,并根据需要对引流管临时剪孔,每例放置1～3条胆道外引流管。8例Ⅳ型肝门部胆管癌根据左右肝管分支角度不同分别采取了不同的方法进行胆道双支架置入。结果:全部病例介入引流手术过程顺利,除2例合并少量胆道出血外,无其他严重并发症发生。术后患者黄疸明显减轻或消退,皮肤瘙痒和胆管炎等症状逐渐消失。术后1～2周,血清胆红素水平由术前的(242.69±27)μmol/L降至(58.32±5.6)μmol/L,差异有统计学意义(t=9.73,P<0.05),收到了较好的近期治疗效果。8例行胆道双支架置入患者中有3例分别于术后4～6个月发生支架再阻塞,黄疸复发,再次行经皮肝穿刺胆道引流治疗。结论:肝门部胆管癌高位胆道梗阻病变复杂,通过引流管剪孔,可在保证引流效果的前提下尽量减少引流管的个数,减少了创伤,方便了术后生活和引流管护理,是对普通胆道外引流管的改良。双支架置入对肝门部Bismuth-Corlett Ⅳ型胆管癌近期疗效可靠,根据左右肝管分叉角度采取不同的双支架置入术式方法可行。Objective To investigate the interventional draining method and clinical therapeutic effect in proximal complicated multibranch biliary obstruction caused by hilar cholangiocarcinoma. Methods A total of 38 patients with complicated obstructive jaundice caused by hilar cholangiocarcinoma （Bismuth II-IV） were enrolled , included 28 males and 10 females, who were aged 53-82 yeas old with a mean age of 71.3. Among them, included Bismuth II 6 cases , Bismuth III 18 cases, and Bismuth IV 14 cases. Based on the obstructive position, extent, and dilated degree of the biliary tract , individual designs were made for the drainage scheme in the different cases. The drainage tubes were improved by cutting lateral aperture,1-3 pieces of biliary external drainage tube were inserted for individual patient. Double biliary stents were implanted in 8 cases after biliary external drainage. Different inserting methods were adopted acording to the branch angles of left and right hepatic ducts . Results The interventional draining operations were successfully completed in all cases and no severe complication happened except for slight hemobilia in 2 patients. The jaundice of all the patients alleviated or disappeared obviously after the operations. The average difference between post- and anti- operation in the serium total bilirubin level was 184.37±29μmol/L（P〈0.05）. Stent restenosis happened and jaundice relapsed in 3 cases after stent implantations 4 to 6 months respectively., and biliary external drainages were made once again. Conclusion It is demonstrated that the improved method of cutting lateral aperture on the drainage tube is convenient with reduced trauma and satisfactory curative effect , a single drainage tube could be used to drain the obstructive bile of more biliary branches, or the general external drainage tube could produce the effect of exterior and interior drainage tube. Acording to the hepatic ducts branch angles ,Adopting different stent inserting methods would be practicable.

关 键 词：肝门部胆管癌 梗阻性黄疸 胆道引流 内支架 介入放射学 

分 类 号：R735.8[医药卫生—肿瘤]