超声引导经皮经肝支架置入在胆道恶性梗阻中的应用临床医学.docVIP

超声引导经皮经肝支架置入在胆道恶性梗阻中的应用临床医学 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：超声引导经皮经肝支架置入在胆道恶性梗阻中的应用临床医学 1 1 资料和方法 2 2 结果 4 3 讨论 5 文2：超声引导下经皮经肝胆囊穿刺引流术治疗急性结石梗阻性胆囊炎临床医学 8 1　资料与方法 8 2　结果 9 3　讨论 10 参考文摘引言： 12 原创性声明（模板） 13 文章致谢（模板） 14 正文 超声引导经皮经肝支架置入在胆道恶性梗阻中的应用临床医学 文1：超声引导经皮经肝支架置入在胆道恶性梗阻中的应用临床医学 【Abstract】 Objective To explore the effect of percutaneous trahepatic 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 trahepatic 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 (%) within postoperative 4 weeks. The survival time was 2-18 months (average 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. Conclusio PTMSP is an ideal palliative therapy under ultrasonic guidance for malignant biliary obstruction and effective PTCD can reduce the relevant complicatio of PTMSP and offer a management for biliary reobstruction. 【Key words】 Biliary obstruction; Stent placement; Percutaneous trahepatic; 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 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、巩膜黄染及肝功异常，血清总胆红素明显升高(～583 μmol/L)。按梗阻部位：高位梗阻(左右肝管汇合平面及以上)2例，其中肝癌、胆囊癌各1例；中位梗阻(肝总管至胆总管中段平面)2例，其中肝癌、胰腺癌各1例；低位梗阻(胆总管下段及以下)12例。本组患者伴有胆道感染6例，陶土便7例，凝血功能异常8例。 仪器及材料 日本Aloka SSD680EX彩超机，探头频率