经皮肝穿胆道引流联合球囊扩张治疗胆肠吻合口良性狭窄的疗效  

Efficacy of percutaneous transhepatic biliary drainage combined with balloon dilatation in the treatment of benign biliary-enteric anastomosis stricture

作　　者：唐凡 任建庄[1] 韩新巍[1] 段旭华[1] 张文广[1] 陈鹏飞[1] 邝东林 李方正[1] 许琳惠 Tang Fan;Ren Jianzhuang;Han Xinwei;Duan Xuhua;Zhang Wenguang;Chen Pengfei;Kuang Donglin;Li Fangzheng;Xu Linhui(Department of Interventional radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学第一附属医院介入科,郑州450003

出　　处：《中华肝胆外科杂志》2020年第4期265-269,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的评价经皮肝穿胆道引流(PTCD)联合球囊扩张治疗胆肠吻合口良性狭窄(BBES)的安全性、可行性及临床疗效。方法回顾性分析郑州大学第一附属医院2013年1月至2019年5月收治的胆肠吻合口良性狭窄33例患者的临床资料,其中良性病因23例,恶性病因10例;15例狭窄位于肝门部,18例狭窄位于肝门外。所有患者术前行磁共振胰胆管成像或增强MRI或增强CT中至少两种影像学检查、肿瘤标记物实验室检查及其他临床资料提示胆肠吻合口良性狭窄。患者首先行经皮肝穿胆道引流并留置外引流管,10例(恶性病因)患者在术前完善肿瘤标记物实验室检查、影像学检查提示为良性狭窄,并在PTCD术中经胆道钳活检病理证实均为良性狭窄。术后间隔1~4周经引流途径行球囊扩张治疗,对比分析术前术后临床症状变化、术前术后胆红素及肝功能指标变化,随访术后患者的吻合口长期通畅率及术后并发症情况。结果所有患者PTCD联合球囊扩张手术顺利,技术成功率100%。术后所有胆肠吻合口良性狭窄程度与临床症状明显改善,未发生严重并发症。术后所有患者的肝功能指标及胆红素较术前下降明显,差异有统计学意义(P<0.05)。术后3个月、6个月、12个月、24个月、36个月时所有患者吻合口通畅率分别为90.9%(30/33)、72.7%(24/33)、63.6%(21/33)、63.6%(21/33)、60.6%(20/33)。随访期间共13例患者出现吻合口良性狭窄复发,其中9例的吻合口良性狭窄部位为肝门部,4例位于肝门外,经再次球囊扩张后保持吻合口长期通畅。联合治疗后胆肠吻合口良性狭窄位于肝门部复发率(60.0%,9/15)比位于肝门外(22.2%,4/18)高,差异有统计学意义(P<0.05)。13例BBES复发者中4例为因恶性病因行胆肠吻合术,9例为良性病因,经第一次球囊扩张术后复发率分别为40.0%(4/10)与39.1%(9/23),复发时间平均分别为5.8个月与6.8个月,差异无统计学意义(P>0.05)�Objective To evaluate the curative effect,safety and feasibility of percutaneous transhepatic cholangio drainage(PTCD)combined with balloon dilatation in treating benign biliary-enteric anastomosis stricture(BBES).Methods The clinical data of 33 patients with benign biliary-enteric anastomosis stricture,who were admitted to the First Affiliated Hospital of Zhengzhou University during the period from January 2013 to May 2019,were retrospectively analyzed.There were 23 cases of benign etiology and 10 cases of malignant etiology,benign strictures of which 15 cases were located in the hepatic hilum and of which 18 cases outside of it.All patients were considered as benign stenosis by at least two imaging examinations of magnetic resonance imaging of pancreatic or enhanced MRI or enhanced CT,laboratory examinations of tumor markers and other clinical data before operation.10 cases of malignant etiology were confirmed by intraoperative biopsy and pathology.All patients were treated with balloon dilatation at an interval of 1 to 4 weeks after PTCD.The changes of clinical symptoms,bilirubin and liver function before and after operation were compared and analyzed,and the postoperative complications and anastomotic patency rate were followed up.Results PTCD combined with balloon dilatation was performed successfully in all patients,and the success rate was 100%.After operation,the benign biliary-enteric anastomosis stricture was significantly improved in all patients,and the clinical symptoms were improved obviously.The liver function and bilirubin decreased significantly in all patients after operation,and there was significant statistical significance(P<0.05).There is no serious complications such as biliary bleeding and biliary fistula were found after operation.At 3 months,6 months,12 months,24 months and 36 months after operation,the anastomotic patency rates of all patients were 90.9%(30/33),72.7%(24/33),63.6%(21/33),63.6%(21/33),60.6%(20/33),respectively.During the whole follow-up period,anastomotic restenosis happe

关 键 词：球囊扩张 经皮肝穿胆道引流术 胆肠吻合口良性狭窄 

分 类 号：R65[医药卫生—外科学]