经皮胆管内支架放置术并发症及发生意外情况的处理方法  

Management of complications during percutaneous implementation of biliary stents

作　　者：张永春[1] 顾占军[1] 邓晓涛[1] 韩京芬[1] 李果珍[1] 

机构地区：[1]卫生部北京医院放射科,100730

出　　处：《中华放射学杂志》2002年第12期1084-1086,共3页Chinese Journal of Radiology

摘　　要：目的　回顾性分析经皮经肝胆管引流术和置入金属内支架过程中的 17例产生并发症或发生意外情况的处理方法。方法　对 64例恶性胆管梗阻的患者行经皮经肝引流和置入金属内支架术 ,17例发生并发症和遇到意外情况。分别为 :心率减慢、血压下降 5例 ;支架脱落在十二指肠1例 ;微导丝断裂 2例 ;胆管穿孔 2例 ;支架位置不佳 3例 ;肝肾功能衰竭导致出血 2例 ;交换导丝折断1例 ;球囊破裂导致支架移位 1例。结果　 5例出现心率减慢、血压下降者 ,对症给予药物治疗或停止操作 ;1例支架脱落在十二指肠 (1枚 )后 ,自动排出体外 ;2例穿刺胆管时微导丝断裂在肝实质内 ,无症状直至病故 ;2例胆管穿孔 ,采用保守治疗均无临床症状 ;3例支架释放后位置不佳 ,再置入短支架 ;2例肝肾衰竭患者愈后差。 1例交换导丝折断在十二指肠内 ,经胃镜取出。 1例球囊破裂导致支架移位 ,再置入 1枚支架。结论　年老体弱和高位胆管梗阻的患者 ,采用经皮胆管内支架放置术是安全有效的方法 ,但有一定难度 ,易出现并发症 。Objective To retrospectively analyze the complications and management of complications during percutaneous implementation of biliary stents in 17 patients. Methods Percutaneous biliary drainage and implementation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 64 patients. 17 cases developed complications. Bradycardia and hypotension was seen in 5 cases, slipping of the stent into the duodenum in 1, bile duct perforation in 2, the fine guidewire broken in the hepatic parenchyma in 2, malposition of the stent in 3, hepato renal failure leading to hemorrhage in 2, exchanging guidewire broken in the duodenum in 1, and balloon broken leading to stent dislocation in 1, respectively. Results Bradycardia and hypotension in the 5 cases was treated medically and the procedure was interrupted. Slipping of the stent into the duodenum was passed off spontaneously. Broken of the fine guidewire in the liver did not present any complaints until the death of the patients. Perforation of bile duct was treated conservatively with a clinical successful outcome. Malposition of the stent was treated by reimplementation of shorter stents. The broken exchanging guidewire in the duodenum during implementation was removed with the gastroscope. The hepato renal failure leading to hemorrhage had poor prognosis. The broken balloon caused stent dislocation was treated by reimplementation of stent. Conclusion Percutaneous implementation of stent is effective and safe for elderly patients with proximal stenosis of the biliary tract. However, one must be very careful to avoid the complications.

关 键 词：肝外胆管阻塞 介入性放射学 支架 评价研究 

分 类 号：R815[医药卫生—放射医学]