双途径介入治疗原发性肝癌合并梗阻性黄疸  

Percutaneous placement of biliary stent for treatment of malignant obstructive jaundice

作　　者：施海彬[1] 刘圣[1] 王杰[1] 冯耀良[1] 陈惠珠[1] 陈玉勤[1] 李麟荪[1] 

机构地区：[1]南京医科大学第一附属医院放射科,210029

出　　处：《介入放射学杂志》2003年第5期352-354,共3页Journal of Interventional Radiology

摘　　要：目的 回顾性分析经皮胆道内支架置入术和动脉内栓塞术双介入途径治疗原发性肝癌合并梗阻性黄疸的技术与疗效。方法 对12例原发性肝癌合并梗阻性黄疸的患者采用在经皮肝穿刺胆道内支架置入术的基础上,行动脉内化疗栓塞术的双介入治疗。肝内肿瘤5例为巨块型,6例为多发结节型,1例为弥漫型,病变均累及肝门部或左右肝管。结果 12例患者共置入14枚支架,3支外引流管。7例左右肝管之间相通,各置入1枚支架;5例左右肝管之间无法相通,分别通过支架或外引流管进行内引流或外引流,其中1例于左右肝管间及左肝管与胆总管之间各置入1枚支架。术后1周,血清总胆红素(TBIL)从术前的(405.3±175.4)μmol/L降至(188.3±101.5)μmol/L(P<0.01),碱性磷酸酶与丙氨酸转氨酶均下降明显(P均<0.05)。术后1个月,TBIL均降至100μmol/L以下,其中5例降至正常范围。胆道引流术后进行肝内肿瘤的动脉内化疗栓塞术1～4次(平均2.1次)。均未出现与介入治疗相关的严重并发症。平均生存9.5个月,5例仍存活。结论 经皮胆道内支架置入术与动脉内栓塞术双途径介入可安全、有效地治疗合并梗阻性黄疸的原发性肝癌,可明显缓解黄疸,改善肝脏功能,延长患者生命。Objective To introduce the techniques of percutaneous biliary stenting and intraarterial embolization for treatment in patients with hepatocellular carcinoma and biliary obstruction accompanying the evaluation of the therapeutic effect. Methods Percutaneous biliary metallic stent placement and intraarterial embolization were performed in 12 patients with hepatocellular carcinoma and obstructive jaundice, with mean age of 52. 3 years old. Results Fourteen stents and 3 external biliary drainage catheters were placed in 12 patients. One stent for each was inserted in 7 patients with communication between right and left hepatic ducts; right and left biliary drainages were separately performed with stents or external biliary drainage catheters in 5 with no communication. The serum total bilirubin decreased from 405.3±175.4 μmol/L before the procedure to 188. 3±101. 5 μmol/L one week after the procedure ( P < 0. 01), and both alkaline phosphatase and transamina.se decreased significantly (P<0.05). Percutaneous transarterial chemoembolization for treatment of hepatocellular carcinoma was done one to four times with average of 2. 1 times after biliary drainage. There were no severe complications related to the interventional procedure. All patients were followed up with an average of 9.5 months, including 5 patients alive. Conclusions The percutaneous biliary stenting and intraarterial embolization are safe and effective palliative therapies in patients with hepatocellular carcinoma and obstructive jaundice. It can alleviate jaundice and improve the liver function with longer survival rate.

关 键 词：介入治疗 原发性肝癌 合并症 梗阻性黄疸 经皮胆道内支架置入术 动脉内栓塞术 

分 类 号：R735.7[医药卫生—肿瘤]