恶性胆道梗阻塑料支架植入后阻塞的介入治疗  

Interventional treatment of biliary obstruction occurring after plastic stent implantation in patients with malignant biliary obstruction

作　　者：唐凡 任建庄[1] 陈鹏飞[1] 张文广[1] 李方正[1] 邝东林 万里 王家兴 韩新巍[1] TANG Fan;REN Jianzhuang;CHEN Pengfei;ZHANG Wenguang;LI Fangzheng;KUANG Donglin;WAN Li;WANG Jiaxing;HAN Xinwei(Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,China)

机构地区：[1]郑州大学第一附属医院介入科、河南省介入治疗与临床研究中心,450052

出　　处：《介入放射学杂志》2021年第12期1276-1281,共6页Journal of Interventional Radiology

摘　　要：目的探讨DSA下恶性胆道梗阻塑料支架植入后阻塞取出、联合经皮经肝途径胆道金属支架植入的安全性、可行性及临床疗效。方法回顾性分析2016年11月至2020年3月收治的经消化内镜置入胆道塑料支架治疗恶性胆道梗阻后支架阻塞的13例患者的临床资料,包括DSA下取出阻塞胆道塑料支架技术成功率、胆道金属支架植入技术成功率、临床治疗成功率(对比分析术前术后白细胞计数、肝功能指标及术后临床症状改善情况)、术后并发症及胆道金属支架通畅率。结果所有患者DSA下取出阻塞的胆道塑料支架与经皮肝穿途径胆道金属裸支架植入手术顺利,技术成功率及临床治疗均获成功。术后所有患者的梗阻性黄疸临床症状明显改善,合并严重感染的患者白细胞计数逐渐恢复正常范围,未发生严重并发症。术后所有患者的转氨酶、胆红素等肝功能指标较术前下降,差异有统计学意义(均P<0.05)。整个随访期间,术后1、3、6、12个月时患者胆道裸金属支架通畅分别有13例、12例、11例和9例,胆道金属支架保持通畅的中位时间为(8.4±3.2)个月。结论对于内镜下置入胆道塑料支架治疗恶性胆道梗阻后发生支架阻塞,DSA下取出阻塞的胆道塑料支架联合经皮经肝穿刺植入胆道金属支架的介入治疗是一种可行、安全、有效的微创手术,值得临床探讨和应用。Objective To investigate the safety,feasibility and clinical efficacy of DSA-guided retrieval of biliary plastic stent which had been implanted for the treatment of malignant biliary obstruction(MBO),and simultaneous percutaneous transhepatic implantation of biliary metal stent.Methods The clinical data of 13 MBO patients with in-stent occlusion,who received endoscopic plastic stent implantation via digestive tract for MBO during the period from November 2016 to March 2020,were retrospectively analyzed.The success rate of DSA-guided retrieval of biliary plastic stent,the success rate of biliary metal stent implantation,the clinical treatment success rate(based on comparing postoperative white blood cell count,liver function and clinical symptom with preoperative ones),postoperative complications and the patency rate of biliary metal stent were collected and analyzed.Results Successful DSA-guided retrieval of biliary plastic stent and percutaneous transhepatic implantation of biliary metal stent were accomplished in all patients.Both the technical success rate and the clinical treatment success rate were excellent.After treatment,the clinical symptoms of obstructive jaundice were obviously improved in all patients,and the elevated leukocyte count in patients having severe infection before operation gradually returned to normal range.No severe complications occurred.Postoperative hepatic function indexes,including the serum levels of transaminase,bilirubin,etc.,were remarkably decreased when compared with the preoperative ones,and the differences were statistically significant.Postoperative one-month,3-month,6-month and 12-month patency rates of metal stent were 100.0%(13/13),92.3%(12/13),84.6%(11/13)and 69.2%(9/13)respectively.The median time of stent remaining in unobstructed status was(8.4±3.2)months.Conclusion For the treatment of occlusion of endoscopy-guided implanted biliary plastic stent,which was performed for the treatment of MBO,DSA-guided retrieval of the plastic stent and simultaneous percutaneous tra

关 键 词：胆道塑料支架 胆道金属支架 经皮肝穿胆道引流术 恶性胆道梗阻 

分 类 号：R735.8[医药卫生—肿瘤]