超声引导经皮经肝支架置入在胆道恶性梗阻中的应用.DOCVIP

临床医学论文-超声引导经皮经肝支架置入在胆道恶性梗阻中的应用 ?????????? 作者：汪涛 田伏洲 蔡忠红 汤礼军 李旭 陈涛 石力　 【摘要】? 目的 探讨超声引导经皮经肝支架置入技术在胆道恶性梗阻中的治疗意义。方法 16例恶性胆道梗阻患者，采用B超引导经皮经肝胆管穿刺置管外引流，并胆道造影后行金属支架置入。结果 胆道支架置入成功率100%，2例术后分别出现胆道及腹腔内出血，保守治疗控制。术后1～4周黄疸消除率87.5%。最短生存时间2个月，最长18个月，中位生存时间6.8个月。6例随访期间出现胆道再梗阻，其中3例经B超引导经皮经肝胆道(PTCD)外引流+胆道冲洗再通，另3例因肿瘤长入，长期PTCD外引流。结论 (1)胆道金属支架减黄效果确切，并能原位恢复胆道的生理连续性；(2)超声介导技术可提高胆道金属支架置入成功率；(3)充分有效的胆汁外引流能减少支架置入的相关并发症，也为胆道再梗阻提出了解决的途径。 【关键词】? 胆道梗阻 支架置入 经皮经肝 超声引导 ?????? 【Abstract】? Objective? To explore the effect of percutaneous transhepatic metallic stent placement (PTMSP) on patients with malignant biliary obstruction (MBO) under ultrasonic guidance (UG). MethodsThe clinical data of 16 patients with MBO were analyzed retrospectively. All the patients underwent percutaneous transhepatic cholangial drainage (PTCD) under UG, and PTMSP was then performed according to cholangiograpy. Results?The successful rate of PTMSP was 100%. Biliary hemorrhage occured in 1 case and abdominal cavity hemorrhage in another after stent placement, but both patients were cured by preservative therapy. Jaundice disappeared in 14 cases (87.5%) within postoperative 4 weeks. The survival time was 2-18 months (average 6.8 months). Biliary reobstruction was found in 6 cases during the followup period, the bile duct was reopened in three of them with the management of PTCD and bile duct flush, and the other 3 cases accepted longterm PTCD. Conclusions? PTMSP is an ideal palliative therapy under ultrasonic guidance for malignant biliary obstruction and effective PTCD can reduce the relevant complications of PTMSP and offer a management for biliary reobstruction. ??? 【Key words】? Biliary obstruction; Stent placement; Percutaneous transhepatic; Ultrasonic guidance ??? 姑息性胆道内引流是治疗胆道恶性梗阻的重要手段，可消除黄疸、控制感染、保护肝脏功能和改善症状。与传统外科手术行胆肠吻合相比较，通过介入技术放置胆道支架不仅能有效引流胆汁，更兼有微创、痛苦少、并发症低和住院时间短等特点，且能实现在原位恢复胆道的生理连续性。我们近年对16例胆道恶性梗阻患者实施了B超引导的经皮经肝金属支架置入术，报告如下。 ??? 1? 资料和方法 ??? 1.1? 临床资料 ??? 多种恶性肿瘤导致胆道梗阻患者16例，男性12例，女性4例，年龄26～78岁，临床上均有不同程度的皮肤、巩膜黄染