交叉支架治疗肝门部胆管癌引起的梗阻性黄疸  

Treatment of Obstructive Jaundice Caused by Hilar Cholangiocarcinoma with Crisscross Stent

作　　者：高健[1] 胡立宝 王煦[1] 陈尘[1] 郅新 洪楠[1] GAO Jian;HU Libao;WANG Xu(Department of Radiology,Peking University People1 s Hospital,Beijing 100044,P.R.China)

机构地区：[1]北京大学人民医院放射科,100044

出　　处：《临床放射学杂志》2021年第1期136-139,共4页Journal of Clinical Radiology

摘　　要：目的探索交叉式支架置入方式,在治疗肝门部胆管癌(HCCA)所致梗阻性黄疸中的可行性及优越性。方法搜集2017年4月至2020年5月9例HCCA引起梗阻性黄疸的患者,行交叉式支架置入,病变均为BismuthⅣ型。手术采用经皮肝穿刺的方式穿刺肝内胆管,若合并严重胆管炎;或肝内胆管迂曲扩张明显,不利于位置关系的判断;或肝门部梗阻严重,导丝不能通过,则先行胆管外引流,择期再行支架置入。若导丝、导管可通过肝门部胆管汇管区,则可行肝门部狭窄段胆管的球囊扩张,然后以"十"型或")("型方式置入内支架。对交叉支架的技术成功率、临床成功率、并发症发生率、支架通畅时间等进行总结分析。结果 9例中8例成功置入交叉支架(7例"十字"交叉,1例")("型交叉),技术成功率88.9%,1例交叉支架无法完成,改行"Y"型支架置入。临床成功率62.5%,平均支架通畅时间221.3天(53~527天),2例术后发生胆管感染,未发生严重胆管出血、腹腔出血、胆汁性腹膜炎等并发症,随访期间2例死亡。结论交叉式支架置入是一种技术成功率较高的解除BismuthⅣ型胆管梗阻的方法,在不增加穿刺通道和支架数量的前提下,理论上可以比现有的支架置入方式多引流约30%的肝脏体积,确切临床疗效尚需大宗病例进一步证实。Objective This study aims to evaluate the feasibility and advantages of percutaneous crisscross configured stent placement in patients with advanced hilar cholangiocarcinoma(HCCA). Methods BetweenApril 2017 to May 2020,percutaneous crisscross configured stent placement was placed for malignant hilar obstruction in 9 patients with advanced HCCA(Bismuth Ⅳ). With patients in the supine position, 10 mg morphine wasinjected subcutaneously for analgesia.Afteradministering local anesthesia at the puncture site with 5-10 ml of 1% lidocaine, weused a 21-gauge puncture needle to puncture the right or left intrahepatic bile duct under fluoroscopy guidance.We usuallyselected the right posterior duct(RPD) as the primary entryduct,manipulatinga 5 F catheter with 0.035 inch diameter super-sliding guide wire entered the left hepatic duct(LHD) through the hilar obstruction.Then we punctured the right anterior duct(RAD),introduced 5 F angiography catheter into the common bile duct(CBD)through the hilar obstruction.The two catheters formed a three-dimensional "十" pattern intersection at the bile ductconfluence.Afterexchanging 0.035-inch stiff guide wire, we used an 8 mm diameter balloon catheter to dilate the hilar stenosis, then two 8 mm diameter self-expanding biliary stents were placed tocover the diseased bile duct.When entering the LHD from the RPD failed due to an acute angle, the catheter can be manipulated into the CBD instead. We then punctured the left intrahepatic bile duct under the xiphoid process, used a guide wire to introduce a 5 F catheter into RAD through the hilar obstruction.The two catheters formed a ")(" type intersection at the bile confluence.After confirming patency of the stents, an 8.5 F external drainage tube was placed in the proximal bile duct of the stent.7-14 days later, after reviewing the cholangiography to confirm that the stents were unobstructed, the drainage tube can be removed.We evaluated the technical success rate, operationtime, clinical success rate, complications, stentpatency, surviv

关 键 词：肝门部胆管癌 Klatskin肿瘤 恶性梗阻性黄疸 支架 透视 

分 类 号：R735.7[医药卫生—肿瘤]