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2~5 d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。
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 were100%. 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.
作者
赵颖
陆雷
吴建伟
王轩
ZHAO Ying;LU Lei;WU Jian-wei;WANG Xuan(Department of Radiology, the 81 th Hospital of PLA, Nanjing 210002, Jiangsu, China)
出处
《东南国防医药》
2018年第3期244-249,共6页
Military Medical Journal of Southeast China
关键词
梗阻性黄疸
恶性肿瘤
胆道支架
胆道引流管
obstructive jaundice
malignant tumor
biliary
stent
biliary
external drainag
