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[1]赵颖,陆雷,吴建伟,等.经皮经肝胆道支架置入及胆管引流治疗恶性梗阻性黄疸的临床分析[J].医学研究与战创伤救治(原医学研究生学报),2018,20(03):244-249.[doi:10.3969/j.issn.1672-271X.2018.03.006]
　ZHAO Ying,LU Lei,WU Jian-wei,et al.Application of three interventional treatment methodson complex malignant obstructive jaundice[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(03):244-249.[doi:10.3969/j.issn.1672-271X.2018.03.006]
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经皮经肝胆道支架置入及胆管引流治疗恶性梗阻性黄疸的临床分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年03期
页码:
244-249
栏目:
出版日期:
2018-05-09

文章信息/Info

Title:
Application of three interventional treatment methodson complex malignant obstructive jaundice
作者:
赵颖; 陆雷; 吴建伟; 王轩
作者单位：210002 南京，解放军第八一医院影像科（赵颖、陆雷、吴建伟、王轩）
Author(s):
ZHAO Ying; LU Lei; WU Jian-wei; WANG Xuan
(Department of Radiology，the 81th Hospital of PLA,Nanjing 210002,Jiangsu，China)
关键词:
梗阻性黄疸; 恶性肿瘤; 胆道支架; 胆道引流管
Keywords:
obstructive jaundice;  malignant tumor;  biliary stent;  biliary external drainag
分类号:
R735.8；R575.7；R814
DOI:
10.3969/j.issn.1672-271X.2018.03.006
文献标志码:
A
摘要:
目的 探讨经皮经肝胆道支架置入及胆管引流的3种方式治疗较复杂恶性梗阻性黄疸的操作难点及对策，提高疗效并减少并发症。方法 80例复杂恶性胆道梗阻患者根据具体情况采用支架置入（单纯支架组，n=53）、支架+外引流（支架+外引流组，n=16）、支架+内外引流（支架+内外引流组，n=11）3种介入手术方式。比较3种方法 的成功率，术前及术后1周、2周血清胆红素等肝功能情况，以及并发症情况。结果 3种方式手术成功率均为100%；3组的术前直接胆红素、总胆红素与术后1周、2周比较差异有统计学意义（P<0.05）。术后1周支架+内引流管、支架+内外引流方式退黄速度相对较快，术后2周3组间退黄效果无明显差异，其中支架+内外引流管方式降低直接胆红素、总胆红素效果相对更优，但并发症偏多。术后2周3组谷丙转氨酶、谷草转氨酶、碱性磷酸酶、γ-谷氨酰转移酶水平分别均有显著下降（P<0.001）。术中、术后并发症：胆心反射5例（单纯支架组3例、支架+外引流组1例、支架+内外引流组1例）、疼痛10例（单纯支架组4例、支架+外引流组3例、支架+内外引流组3例）、胆道少量出血8例（单纯支架组5例、支架+外引流组2例、支架+内外引流组1例），胆道感染3例（支架+外引流组1例、支架+内外引流组2例），经对症处理后2～5d均缓解。无大出血、胆汁瘘、败血症等严重并发症。结论 较复杂恶性胆道梗阻采用支架与引流管的3种置入方式对解除胆道梗阻、改善临床症状是安全、有效的方法 ；准确判断、合理选择方案及细节处理完善可以显著提高手术成功率、减少并发症。
Abstract:
Objective To investigate the operative difficulties and strategies of three Methods of percutaneous transhepatic biliary stent implantation and biliary drainage for the treatment of complicated malignant obstructive jaundice, and to improve the curative effect and reduce complications.Methods 80 patients with complicated malignant obstructive jaundice were treated by stenting (group of stenting, n=53), stenting and external drainage (group of stenting and external drainage, n=16), stenting and internal-external drainage (group of stenting and internal-external drainage, n=11). The achievement ratio, complications, serum bilirubin level of one week and two weeks after operation were compared among three Methods .Results The success rate of the three Methods were 100%. There were 53 cases in group of stenting, 16 cases in group of stenting and external drainage, 11 cases in group of stenting and internal-external drainage respectively. There were significant differences in total bilirubin level between pre-operation and one week after operation, between pre-operation and two week after operation among three groups respectively (P＜0.05). The effect of reducing jaundice was better in group of stenting and internal-external drainage and group external drainage than that in another group one week after operation. There was no significant difference among the three groups in the effect of reducing jaundice two weeks after operation,the group of stenting and internal-external drainage were the best among three groups. Among the three groups, the level of glutamate pyruvate transaminase, glutamic oxalacetic transaminase, alkaline phosphatase and γ-GT had reduced significantly after two weeks respectively (P＜0.001). Intraoperative and postoperative complications included 5 biliary-cardiac reflex (3 in group of stenting,1 in group of stenting and external drainage,1 in group of stenting and internal-external drainage),pain in 10 cases(4 in group of stenting,3 in group of stenting and external drainage, 3 in group of stenting and internal-external drainage), 8 biliary tract bleeding(5 in group of stenting, 2 in group of stenting and external drainage,1 in group of stenting and internal-external drainage), 3 biliary infection(1 in group of stenting and external drainage, 2 in group of stenting and internal-external drainage), all of these complications were relieved 2 to 5 days later by symptomatic treatment. There were no serious complications such as massive bleeding, bile fistula and septicemia.Conclusion Three Methods of percutaneous transhepatic stending and biliary drainage had relieved biliary obstruction and improved clinical symptoms, which were safe and effective method for complex malignant biliary obstruction. Accurate judgment, reasonable option and handling in details can improve the effect and reduce the complications significantly.

参考文献/References:

[1]葛贤秀,李全朋,缪林.胆管癌的治疗现状与进展[J].医学研究生学报，2012,25(5):520-523.
[2]游淑红,洪涛,陶荣,等.彩色多普勒超声引导下经皮经肝胆管穿刺置管引流术40例分析体会[J].东南国防医药,2015,17(6):619-621.
[3]Hong HP, Seo TS, Cha IH, et al. Percutaneous placement of self-expandable metallic stents in patients with obstructive jaundice secondary to metastatic gastric cancer after gastrectomy[J]. Korean J Radiol，2013,14(5):789-796.
[4]Garcarek J, Kurcz J, Guziński M, et al. Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice[J]. Adv Clin Exp Med, 2012, 21(5):621-32.
[5]Hyun H, Choi SY, Kim KA, et al. Safety and efficacy of percutaneous biliary covered stent placement in patients with malignant biliary hilar obstruction; correlation with liver function[J].Cardiovasc Intervent Radiol, 2016, 39(9):1298-1305.
[6]武中林,李顺宗,杨光,等.超声引导肝内胆管穿刺在老年高位恶性胆道梗阻中的应用[J].中国介入影像与治疗学，2017,14(6):365-369.
[7]Nennstiel S, Weber A, Frick G, et al. Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years[J]. J Clin Gastroenterol, 2015, 49(9):764-70.
[8]李成学,杨凯,张虹.梗阻性黄疸介入治疗中胆心反射的防治[J].中国介入影像与治疗学，2017,14(5):283-286.
[9]袁征,何宗亮.胆管癌介入术后再梗阻的原因分析[J].现代仪器与医疗,2017,23(4):31-33.
[10]刘焕亮,石荣书,陈卫斌.多侧孔导管在胆道梗阻性疾病介入操作术中的应用[J].医学影像学杂志,2013,23(6):921-923.
[11]Li M，Bai M，Qi X，et al.Percutaneous transhepatic biliary metal stent for malignant hilar obstruction: results and predictive factors for efficacy in 159 patients from a single center[J]. Cardiovasc Intervent Radiol，2015, 38(3):709-721.
[12]吴穹,朱海东,郭金和,等.恶性胆道梗阻治疗现状及进展[J].东南大学学报(医学版),2014,33(5):639-643.
[13]Gwon DI, Ko GY, Sung KB,et al. Clinical outcomes after percutaneous biliary interventions in patients with malignant biliary obstruction caused by metastatic gastric cancer[J]. Acta Radiol，2012, 53(4):422-429.
[14]夏宁, 程永德, 王忠敏. 胆道支架再狭窄的介入治疗[J]. 介入放射学杂志, 2014, 23(1):82-86.
[15]Melenhorst MC,Scheffer HJ,Vroomen LG,et al.Percutaneous irreversible electroporation of unresectable hilar cholangiocarcinoma (Klatskin Tumor): A case report[J].Cardiovasc Intervent Radiol，2016,39(1):117-121.
[16]马少军,翟仁友,赵峰.恶性梗阻性黄疸的介入治疗进展[J].中华介入放射学电子杂志,2016,2(4):119-123.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2018-05-20