超声引导经皮经肝穿刺胆管置管引流治疗晚期恶性梗阻性黄疸

目的 探讨超声引导经皮经肝穿刺胆管置管引流(percutaneoua transhepatic cholangial drainage,PTCD)治疗晚期恶性梗阻性黄疸的临床应用价值.方法 晚期恶性梗阻性黄疸28例,在B超引导下采用静脉导管施行胆管置管引流.结果 28例1次置管成功率96.43%(27/28),2次置管成功率100%(1/1),引流量360～800 mL/d,1周后血清总胆红素降至85.5～170.1 μmol/L.结论 超声引导经皮经肝穿刺胆管准确性高、灵活、安全、实时.采用静脉导管置管引流安全实用,价格低廉,值得推广.     

PTBD及PTIBS治疗胆道恶性梗阻的临床研究

目的:探讨经皮经肝胆管引流术(percutaneous transhepatic biliary drainage,PTBD)和经皮经肝胆管内支架引流术(percutaneous transhepatic insertion of biliary stent,PTIBS)治疗恶性梗阻性黄疸的技术,疗效及并发症。方法:172例恶性胆道梗阻患者在影像监视下行PTBD或PTIBS,术后10天复查血清总胆红素和直接胆红素。结果:172例恶性胆道梗阻患者,行外引流者123例,行内外引流者34例,行胆道支架置入者15例。技术操作成功率100%。所有患者术后第10天血清总胆红素和直接胆红素明显下降,肝功能改善,差异有统计学意义(P<0.005)。结论:PTBD和PTIBS是治疗恶性梗阻性黄疸的有效方法,具有创伤小、操作简便、安全性高的优点。     

PTBD及PTIBS治疗胆道恶性梗阻的临床研究

目的：探讨经皮经肝胆管引流术（percutaneous transhepatic biliary drainage,PTBD）和经皮经肝胆管内支架引流术（percutaneous transhepatic insertion of biliary stent,PTIBS）治疗恶性梗阻性黄疸的技术,疗效及并发症。方法：172例恶性胆道梗阻患者在影像监视下行PTBD或PTIBS,术后10天复查血清总胆红素和直接胆红素。结果：172例恶性胆道梗阻患者,行外引流者123例,行内外引流者34例,行胆道支架置入者15例。技术操作成功率100%。所有患者术后第10天血清总胆红素和直接胆红素明显下降,肝功能改善,差异有统计学意义（P〈0.005）。结论：PTBD和PTIBS是治疗恶性梗阻性黄疸的有效方法,具有创伤小、操作简便、安全性高的优点。     

超声引导下经皮肝穿刺胆道引流联合胆管复合支架置入术治疗晚期肝外胆管癌的效果

目的 探讨超声及CT引导下经皮肝穿刺胆道引流(PTCD)联合胆管复合支架置入术治疗晚期肝外胆管癌的效果.方法 将98例晚期肝外胆管癌患者按术前引导方式不同分为超声组(n=52)和CT组(n=46),两组均给予PTCD联合胆管复合支架置入术治疗,观察两组患者一次穿刺成功率、肝功能指标、并发症发生情况及生存情况.结果 超声组患者一次穿刺成功率高于CT组,并发症总发生率低于CT组,差异均有统计学意义(P﹤0.05).术前,超声组和CT组患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(ALP)水平比较,差异均无统计学意义(P﹥0.05);术后7天,两组患者ALT、AST、TBIL、DBIL和ALP水平均较术前降低(P﹤0.05),且超声组患者ALT、AST、TBIL、DBIL和ALP水平均明显低于CT组(P﹤0.01).术前及术后7天,两组患者血清Na+、K+水平比较,差异均无统计学意义(P﹥0.05).两组患者生存情况比较,差异无统计学意义(P﹥0.05).结论 相比较CT引导,超声引导下PTCD联合胆管复合支架置入术治疗晚期肝外胆管癌有较好的效果.     

胆管支架治疗恶性梗阻性黄疸５３例分析

目的　观察经皮肝穿刺肝胆管支架治疗恶性梗阻性黄疸的疗效及不良反应。方法　５３例恶性胆道梗阻患者采用经皮肝穿刺置入胆管支架治疗,术前及术后１周复查血清总胆红素、直接胆红素。２２例患者行肝动脉栓塞化疗（ＴＡＣＥ）。结果　共置入５５枚镍钛形状记忆合金内支架,其中２例各置入２枚胆道支架,技术操作成功率１００％。术前及术后１周血清总胆红素、直接胆红素均有显著差异（Ｐ＝０.０２１,Ｐ＝０.０１８）,支架置入后行ＴＡＣＥ者中位生存期（３９.２周）明显高于未行ＴＡＣＥ组（１７.３周）,术中及术后的并发症经及时处理后均能缓解。结论　对梗阻性黄疸患者经皮肝穿刺支架治疗对解除胆道梗阻是一种安全、有效的方法。术后行肝动脉栓塞化疗者能明显延长患者生存。     

经皮肝穿胆道支架置入治疗恶性胆道梗阻的临床研究

目的:总结经皮肝穿刺胆道金属内支架植入治疗恶性胆道梗阻的临床疗效及经验.方法: 92例恶性胆道梗阻性黄疸患者,采用经皮肝穿刺肝胆管支架置入术.根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式.结果: 92 例患者中,91例胆道支架成功放置,其中12例放置双支架,支架扩张良好,引流通畅,血清胆红素下降明显.术后死亡2例,胆道出血3例,腹水渗漏6例,胆漏2例,支架移位1例,胆管炎9例,胆道再阻塞11例.结论对不能手术的恶性胆道梗阻性黄疸患者,经皮肝穿刺胆道内支架植入术创伤小,可提高患者的生存质量,延长生存期,是一种较为安全、有效的方法.     

彩超引导下经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸的应用及体会

超声引导下经皮经肝胆管引流(PTCD)是对恶性肿瘤引起的梗阻性黄疸的姑息性治疗,对估计有切除可能的恶性肿瘤梗阻引起的黄疸术前准备所行的一种有效方法[1],具有手术简捷、患者痛苦小、感染率低等优点。我院于2003年8月~2006年6月用彩超引导对106例肿瘤致梗阻性黄疸患者行PTCD术,现报告如下:1资料与方法1.1临床资料106例梗阻性黄疸为我院住院或门诊的肿瘤患者。男性78例、女性28例,年龄26~92岁。106例经超声、CT、胆管影像学结合临床诊断为恶性肿瘤(其中17例经术后手术病理证实),并引起均阻塞性黄疸,其中胆管下段癌52例、肝门部位胆管癌1…     

经皮肝穿胆道支架置入治疗恶性胆道梗阻的临床研究

目的：总结经皮肝穿刺胆道金属内支架植入治疗恶性胆道梗阻的临床疗效及经验。方法：92例恶性胆道梗阻性黄疸患者,采用经皮肝穿刺肝胆管支架置入术。根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式。结果：92例患者中,91例胆道支架成功放置,其中12例放置双支架,支架扩张良好,引流通畅,血清胆红素下降明显。术后死亡2例,胆道出血3例,腹水渗漏6例,胆漏2例,支架移位1例,胆管炎9例,胆道再阻塞11例。结论对不能手术的恶性胆道梗阻性黄疸患者,经皮肝穿刺胆道内支架植入术创伤小,可提高患者的生存质量,延长生存期,是一种较为安全、有效的方法。     

经皮肝穿刺胆管引流联合三维适形放疗治疗肝门部癌伴梗阻性黄疸

目的观察经皮肝穿刺胆管引流（PTCD）联合三维适形放疗（3D-CRT）治疗肝门部癌伴梗阻性黄疸的临床疗效。方法对26例肝门部癌伴梗阻性黄疸患者行经PTCD,胆红素下降后行3D-CRT。结果 26例患者均引流成功,术后胆红素均较术前明显下降（P〈0.05）;行3D-CRT后总有效率73.08%,中位生存期14.5个月。全组无治疗相关的严重并发症。结论 PTCD联合3D-CRT治疗肝门部癌伴梗阻性黄疸近期疗效好,且安全性高。     

恶性高位胆道梗阻经皮经肝胆道引流方式的疗效分析

目的:探讨恶性高位胆道梗阻患者经皮经肝胆道引流方式对术后近远期疗效影响,为临床选择适当的治疗方式提供依据.方法:回顾性分析我院108例恶性高位胆道梗阻患者,比较单侧引流(68例)和双侧引流(40例),左右肝管是否相通,引流材料对近期胆红素下降值和生存情况的影响.结果:三组术后3-5天胆红素的下降值明显,但无统计学差异(P＞0.05).随访1-36个月,单侧组和双侧组、单枚引流管与单枚支架生存率没有显著差异(P＞0.05).结论:恶性高位胆道梗阻以右侧入路单侧引流为主,生存期预计大于3个月,放置胆道支架,否则置入胆道引流管.     

经导管肝动脉化疗栓塞术后并发肝脓肿的临床护理

目的总结并探讨B超引导下经皮穿刺置管引流治疗经导管肝动脉化疗栓塞术（TACE）后并发肝脓肿患者的临床护理措施及要点。方法回顾性分析2008年3月至2012年11月间6例行TACE介入术后并发肝脓肿患者的资料。6例患者的治疗均予经皮穿刺置管引流方法，围手术期间给予术前准备与心理护理、术后生命体征监测与对症护理、置管后围导管护理、营养支持与并发症预防等护理干预措施，观察实施效果。结果5例患者置管10～15d后引流量逐渐减少，经B超或CT检查，脓腔显著缩小或接近闭合，稳定2d后成功拔管。l例多发性肝脓肿患者脓肿破裂并发感染性休克，于置管后32d死于肝功衰竭。结论在准确判定肝脓肿形成并行置管引流基础上，做好生命体征监测与病情观察、围导管护理及对症护理措施，是减少并发症，促进脓肿愈合的必要和有效措施。     

Percutaneous transhepatic cholangial drainage: direct approach under fluoroscopic control.

We devised a direct percutaneous transhepatic cholangial drainage under fluoroscopic control. The principle is as follows. After percutaneous transhepatic cholangiography, the three dimensional structure of intrahepatic bile ducts is projected to a two dimensional plane under fluoroscopy; the needle can then be introduced into the selected bile duct with accuracy. The technique can be used as a preoperative management of operations of patients with jaundice and also as a palliative management of advanced cancer without much complication.     

彩色多普勒超声成像引导下经皮经肝胆管穿刺置管引流术的应用价值

目的 探讨经彩色多普勒超声成像(CDFI)引导下经皮经肝胆管穿刺置管引流术(PTCD)的临床应用价值.方法 在CDFI引导下对224例恶性胆道梗阻性黄疸患者行PTCD术置管248根次,选择左肝外叶下段胆管(左路)118根次,右肝胆管(右路)130根次,其中左右肝胆管分别置管者16根次.结果 224例248根次置管总成功率为99.59%(247/248),一针成功率为92.33%(229/248),其中一针左路成功率[96.61%(114/118)]明显高于右路[88.46%(115/130)],差异有统计学意义(P＜0.05).结论 CDFI引导下PTCD安全、简便、微创、成功率高,是治疗阻塞性黄疸的有效方法.     

Analysis of Different Ways of Drainage for Obstructive Jaundice Caused by Hilar Cholangiocarcinoma

Objective: To evaluate the prognosis of different ways of drainage for patients with obstructive jaundicecaused by hilar cholangiocarcinoma. Materials and Methods: During the period of January 2006- March 2012,percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) wereperformed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainagewas selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if itcould. External drainage was the first choice if infection was diagnosed before the procedure, and a metallicstent was inserted in one week after the infection was under control. Selection by new infections, the degree ofbilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients asthe parameters was conducted to evaluate the methods of different interventional treatments regarding prognosisof patients with hilar obstruction caused by hilar cholangiocarcinoma. Results: PTCD was conducted in 6 patientsand PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05).The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). Conclusions: Withboth drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liverfunction was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.     

Efficacy of percutaneous transhepatic cholangiodrainage (PTCD) in patients with unresectable pancreatic cancer

For patients with pancreatic cancer who suffer from obstructive jaundice, percutaneous transhepatic cholangiodrainage (PTCD) is the treatment of choice. However, there are no standards for palliative care for patients undergoing this treatment. The aim of this study was to retrospectively evaluate the efficacy of post-palliative treatment in patients with unresectable pancreatic cancer who were previously treated with PTCD. The 47 patients included in this study had unresectable pancreatic cancer, presented with obstructive jaundice, had no prior history of chemotherapy, and underwent PTCD. They were divided into two groups. Group A was composed of 21 patients who received post-palliative treatment (chemotherapy, radiation, or chemoradiotherapy). Group B consisted of 26 patients who were under best supportive care (BSC). We compared the median overall survival time between the two groups to evaluate the efficacy of post-palliative treatment. The median overall survival time (MOST) of patients undergoing PTCD was 7.19 months. MOST was 9.07 months for patients in group A (P?=?0.017 vs. group B) and 5.52 months for those in group B. Among the patients receiving post-palliative treatment, 12 (57 % of patients) received only a single therapy (either chemo or radiation), and 9 (43 %) received chemoradiotherapy. Their median overall survival times were 8.31 and 11.15 months, respectively (P?=?0.325). Post-palliative treatment in patients with unresectable pancreatic cancer previously treated with PTCD is more effective than only best supportive care alone. Patients receiving both chemo and radiation may benefit more in terms of overall survival compared to patients receiving only one or the other.     

A case of advanced gastric cancer with obstructive jaundice that responded to TS-1/CPT-11 combination therapy after percutaneous transhepatic cholangio drainage

TS-1/CPT-11 combination therapy was carried out in a case of advanced gastric cancer with liver and lymph node metastases and obstructive jaundice after percutaneous transhepatic cholangio drainage (PTCD). Regression of the primary carcinoma and reduction in size of metastases were observed. Grade 1 fatigue and grade 2 neutropenia were noted as adverse reactions to the treatment. TS-1/CPT-11 combination therapy was useful in this case of advanced gastric cancer with liver and lymph node metastases.     

Percutaneous transhepatic biliary drainage in malignant obstructive jaundice

Results obtained in 70 patients with neoplastic (primary or metastatic) biliary obstruction and submitted to percutaneous transhepatic biliary drainage indicate the effectiveness of the technique in relieving jaundice, improving general conditions and restoring liver function. In 25.4% of cases, the drainage allowed the patients to undergo surgical treatment of the neoplasm. In 74.6%, the drainage was left in place as definitive palliation. The complication rate was very low and similar to that described in the literature. At this time it is difficult to identify prognostic factors and foresee the results of percutaneous transhepatic biliary drainage, but the procedure is always indicated in patients at high operative risk or inoperable.     

PTC下胆道活检诊断恶性阻塞性黄疸的临床应用

目的　探索PTC下胆道活检的可行性和敏感性 ,获取病变胆管的组织病理学 ,指导临床治疗。方法　 19例恶性阻塞性黄疸 ,在行PTCD(经皮经肝穿刺胆道内外引流术 )减黄术中 ,PTC下胆道活检 ,进行组织病理学检查。结果　 19例患者中有 18例获得组织病理学诊断 (敏感性 ,94 74% )。病理报告为胆管癌n =13 ,胰腺癌n =2 ,转移瘤n =2 ,肝细胞癌n =1,阴性结果n =1,阳性结果率为 94 74%。结论　PTC胆道活检是一种准确可靠的获取组织病理学检查途径