胆道支架联合125Ⅰ粒子条治疗恶性梗阻性黄疸的护理

性梗阻性黄疸，在重新开通闭塞胆道的同时，联合125Ⅰ粒子条腔内照射治疗控制肿瘤生长，从而延缓阻塞性黄疸复发，在提高患者生活质量上有明显疗效。作为护理人员，了解胆道支架联合125Ⅰ粒子条治疗的方法和观察要点，制定切实有效的护理措施尤为重要。现将我院收治的36例恶性梗阻性黄疸病例经胆道支架联合125Ⅰ粒子条治疗的护理体会报告如下。     

胆道支架联合~(125)I粒子条治疗恶性梗阻性黄疸的护理

<正>恶性梗阻性黄疸(Malignant obstructive jaun-dice,MOJ)是临床常见病症,多由恶性肿瘤侵犯、闭塞胆管引起,外科切除是治疗MOJ首选方法。但MOJ确诊时肿瘤多已侵犯周围组织,肿瘤的手术切除率不足20%[1]。我院2012年3月-2014年2月,采用胆道支架联合125I粒子条腔内照射治疗恶性梗阻性黄疸,在重新开通闭塞胆道的同时,联合125I粒子条腔内照射治疗控制肿瘤生长,从而延缓阻塞性黄疸复发,在提高患者生活质量上有明显疗效。作为护理人员,了解胆道支架联合125I粒子条     

经皮经肝胆道内支架置入术在恶性梗阻性黄疸中的应用

目的探讨经皮经肝胆道内支架置入术治疗恶性梗阻性黄疸的疗效。方法对18例恶性梗阻性黄疸患者行经皮、肝穿刺胆内支架置入治疗。结果 18例患者共成功置入支架20枚,术后梗阻胆道的通畅率100%,症状体征明显缓解,术后1周血清总胆红素水平较术前显著下降(P﹤0.05)。结论经皮肝穿刺胆道内支架置入术治疗恶性梗阻性黄疸可延长患者生存期,对失去外科手术机会的部分恶性梗阻性黄疸患者是一种较为理想的非手术方法。     

胆道成形术在恶性梗阻性黄疸治疗中的应用价值

目的 探讨胆道成形术(经皮胆道引流及支架置入)治疗恶性梗阻性黄疸的临床疗效及应用价值.方法 在DSA下对80例梗阻性黄疸患者行经皮肝胆管穿刺置管引流以及胆道内支架置入,观察临床症状和黄疸的改善情况.结果 80例患者穿刺置管引流术均置管成功,其中60例单支架置入,20例双支架置入.术前血清总胆红素(200.67±48)μmol/L,术后1周、2周及3周血清总胆红素分别下降到(140.2 ± 42.8)μmol/L、(90.3±26.5)μmol/L及(60.6±36.5)μmol/L.其中32例患者临床症状改善后行化疗以及放射治疗.结论 胆道成形术可明显改善恶性胆道梗阻的临床症状,提高患者生活质量,为进一步治疗创造条件.     

经内镜胆道金属支架引流术治疗恶性胆道梗阻性黄疸

目的:探讨经内镜胆道金属支架引流术治疗恶性胆道梗阻性黄疸的疗效和安全性。方法:42例无法行手术根治性切除的恶性胆道梗阻性黄疸患者采用内镜下胆道金属支架引流术治疗。并观察血清胆红素水平及术后并发症情况,随访患者生存期和胆道支架维持通畅时间。结果:42例患者放置胆道金属支架均获成功,成功率为100.0%(42/42);术后2周内血清胆红素恢复正常30例(71.4%),明显减退12例(28.6%);2例(4.8%)发生胆管炎,3例(7.1%)发生急性轻型胰腺炎;平均支架维持通畅时间为9.6个月;6个月和1年生存率分别为64.3%(27/42)和19.0%(8/42)。结论:经内镜胆道金属支架引流术治疗恶性胆道梗阻性黄疸疗效较好,并发症少。     

ERBD治疗难以切除的恶性胆道梗阻

目的探讨内镜下逆行胆道内引流术(ERBD)对难以切除的恶性胆道梗阻的姑息性治疗作用.方法通过十二指肠镜对41例由7种晚期恶性肿瘤引起的梗阻性黄疸患者,施行逆行胆道内支架植入术,全部获成功.结果38例患者血清总胆红素降至正常,另3例下降约50%.结论ERBD能有效控制恶性胆道梗阻患者的黄疸,是临床上一种可供选择的微创方法.     

内镜下胆道支架治疗恶性胆道梗阻

目的 :探讨内镜下胆道支架对恶性梗阻性黄疸的治疗效果和临床应用价值。方法 :选择 2 5例无法手术根治性切除的恶性胆道梗阻患者 ,内镜下放置胆道支架。结果 :2 5例放置胆道支架均获成功 ,术后二周内血清胆红素恢复正常 17例 ( 68%) ,明显减退 8例 ( 3 2 %) ,2例 ( 8%)发生胆管炎。随访 6个月 ,4例死亡 ,9例发生支架阻塞再行支架置换术 ,3例失访。结论 :内镜下胆道支架可有效缓解恶性胆道梗阻病人的病情 ,具有创伤小 ,并发症少 ,符合生理等特点 ,对无法手术根治性切除的恶性胆道梗阻病人 ,内镜下放置胆道支架是最佳的首选治疗方法     

158例恶性梗阻性黄疸患者行PTCD及胆道支架置入术的护理

目的：探讨经皮肝穿刺胆道引流(PTCD) 胆道支架置入治疗恶性梗阻性黄疸患者疗效观察及总结护理要点。方法：对158例恶性梗阻性黄疸患者行PTCD 胆道内支架置入术,包括术前、中、后实施相应的护理,观察及并发症的发生率、临床效果的评估。结果：158例患者治疗时皮肤巩膜重度黄染、骚痒、伴腹胀,纳差,肝功能严重损伤,经采用一系列治疗7～10天后皮肤巩膜黄染、瘙痒明显消退,腹胀缓解,肝功能改善,食欲提高。结论：恶性梗阻性黄疸患者经PTCD 胆道内支架置入治疗后,给予对症护理,患者可明显改善黄疸及伴随症状,提高生活质量,延长生存期。     

经皮肝穿刺胆道腔内射频消融联合胆道支架治疗恶性胆道梗阻的初步研究

目的探讨经皮肝穿刺胆道腔内射频消融技术姑息性治疗恶性梗阻性黄疸的安全性及可行性。方法前瞻性纳入20例恶性梗阻性黄疸且不能外科手术切除患者,行透视下经皮肝穿刺胆道腔内射频消融术,并常规留置金属胆道支架及胆道外引流管,观察手术并发症及黄疸缓解情况并密切随访。结果所有患者均顺利完成胆道腔内射频消融治疗并留置金属胆道支架及胆道外引流管。术后未出现胆道出血、穿孔等并发症,2例患者出现胆管炎,内科保守治疗后好转;7 d黄疸缓解率为65％（13/20）;5例患者在术后因晚期肿瘤严重消耗死亡,余患者均存活;3例患者在术后5～6个月黄疸复发,再次行腔内射频治疗后好转;总体1个月支架通。率100％（20/20）,3个月支架通。率100％（20/20）,6个月支架通。率85％（17/20）;1个月存活率100％（20/20）,3个月存活率95％（19/20）,6个月存活率75％（15/20）。结论作为一种新式的姑息治疗手段,经皮肝穿刺胆道腔内射频消融对恶性胆道梗阻的治疗是安全和可行的,初步疗效令人满意,但尚需大量样本的随机性及前瞻性研究,远期疗效有待进一步探讨。     

经皮胆道支架置入治疗恶性梗阻性黄疸的护理探讨

经皮胆道支架置入治疗恶性梗阻性黄疸,具有创伤小,并发症少的特点,能迅速解除胆管癌、胰腺癌引起的恶性梗阻,减轻黄疸,改善黄疸引起的各种临床症状,提高患者的生存质量,是治疗梗阻性黄疸理想的非外科手术方法[1]。2004年1月-2005年12月,我院对21例恶性梗阻性黄疸患者采用经皮胆     

不同途径胆管支架置入术治疗恶性梗阻性黄疸

目的探讨经皮经肝胆管穿刺引流、内镜逆行胰胆管造影及手术中行胆管支架置入治疗恶性梗阻性黄疸的效果。方法回顾性分析116例行金属胆管支架置入术治疗恶性梗阻性黄疸患者的临床资料。结果经皮经肝胆管穿刺引流置入支架成功率为88.1%,并发症发生率为4.8%,中位生存时间为27周;经内镜逆行胰胆管造影置入支架成功率为86.0%,并发症发生率为5.3%,中位生存时间为25周;手术中胆管支架放置成功率为100%,并发症发生率为13.3%,中位生存时间为23周。结论经皮经肝胆管穿刺引流及经内镜逆行胰胆管造影胆管支架置入术可作为恶性梗阻性黄疸患者姑息性治疗的首选方法。     

Biliary stent combined with iodine-125 seed strand implantation in malignant obstructive jaundice

BACKGROUNDMalignant obstructive jaundice is mainly caused by cholangiocarcinoma. Only a few patients are indicated for surgical resection, and the 3-year survival rate is < 50%. For patients who are not eligible for surgery, biliary stent placement can relieve biliary obstruction and improve liver function and quality of life. However, restenosis after biliary stents has a poor prognosis and is a clinical challenge. Biliary stent combined with iodine-125 (¹²⁵I) seed implantation can prolong stent patency and improve survival.AIMTo evaluate the safety and efficacy of biliary stent combined with ¹²⁵I seed strand implantation in malignant obstructive jaundice. METHODSWe enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with ¹²⁵I seed strand treatment (combined) group (n = 32) and biliary stent (control) group (n = 35). All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers. Twelve patients underwent pathological examination before surgery. All patients were followed up by telephone or clinical visit. Postoperative liver function improvement, postoperative complications, stent patency time, and survival time were compared between the two groups. Prognostic risk factors were evaluated. RESULTSTechnical success was achieved in all patients in both groups. Postoperative liver function improved significantly in all patients (total bilirubin, direct bilirubin, alanine aminotransferase, and aspartate aminotransferase decreased significantly in all patients, the P values were less than 0.05). There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin (P = 0.147), direct bilirubin (P = 0.448), alanine aminotransferase (P = 0.120), and aspartate aminotransferase (P = 0.387) between the two groups. The median stent patency time of the combined group was 9.0 ± 1.4 mo [95% confidence interval (CI): 6.3-11.8 mo], which was significantly longer than the that of the control group (6.0 ± 0.3 mo, 95%CI: 5.5-6.5 mo, P = 0.000). The median survival time of the combined group was 11.0 ± 1.4 mo (95%CI: 8.2-13.7 mo), which was significantly longer than that of the control group (7.0 ± 0.3 mo, 95%CI: 6.4-7.6 mo, P = 0.000). Location of obstruction and number of stents were independent risk factors affecting prognosis.CONCLUSIONBiliary stent combined with ¹²⁵I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.     

超声在肝外胆管癌腔内125I 粒子持续照射治疗中的应用价值

目的：探讨超声在肝外胆管癌腔内^125I粒子持续照射治疗中的应用价值。方法：对经十二指肠镜行病变胆管扩张后置人支架和^125I粒子的肝外胆管癌患者术前术后进行超声检查，确定病变部位、范围，观察支架及粒子的位置，评价疗效，及时发现并发症。结果：12例患者术前超声均可诊断肝外胆道梗阻，其中胆总管中段病变均能显示（4例），胆总管末端及胆肠吻合处的病变较难发现，仅发现50％（4／8）；支架术后沿支架扫查，病变检出率达91．67％（11／12）；术后检查，发现支架堵塞2例、放置粒子前瘤组织长人支架内1例、肝脓肿1例；肿块治疗后无明显增大，未见周围淋巴结转移。结论：超声在肝外胆管癌腔内持续照射治疗术前诊断、术后随访及疗效评价中具有一定的临床应用价值。     

应用自膨式金属支架姑息治疗无法手术的恶性梗阻性黄疸

目的 评价自膨式金属支架植入成形术治疗无法手术的恶性梗阻性黄疸及临床疗效.方法 对105例无法手术治疗的恶性梗阻性黄疸患者行胆道内支架成形术,术后随访3～755天,观察患者的临床症状改善情况及支架通畅情况.结果 共植入支架129枚,初次治疗的技术成功率为94.3%,78%患者术后达到临床显效的标准.术后30天患者死亡率为7.6%(8/105),死因均与介入操作无关.术后患者的中位生存期为189天,支架中位通畅时间为246天.术后3、6个月的支架通畅率分别为92.1%和64.5%.结论 自膨式金属支架植入术是姑息治疗恶性梗阻性黄疸的有效方法,准确判断无法从胆道支架成形术中获益患者将有助于改善支架成形术后的远期疗效.     

经内镜胆道支架置放治疗胆道恶性梗阻性疾病

目的 :探讨经内镜胆道支架置放治疗胆道恶性梗阻性疾病。方法 :有 2 4例胆道恶性梗阻病人接受治疗 ,其中 11例被放置金属支架 ,13例被放置塑料支架。结果 :插管成功率 89% ,并发症 2例 ,急性胰腺炎和急性胆管炎各 1例 ,并发症发生率 7.4 %。血清胆红素由 2 89umol/L下降到术后 1周的 10 4umol/L。3个月、6个月存活率分别达 95 %及 78%。结论 :经内镜胆道支架置放治疗胆道恶性梗阻性疾病是安全、有效的方法     

Ofloxacin and ursodeoxycholic acid versus ursodeoxycholic acid alone to prevent occlusion of biliary stents: a prospective, randomized trial.

BACKGROUND AND STUDY AIMS: Biliary plastic stents are highly effective in the treatment of malignant biliary obstruction, but may become occluded over time, leading to jaundice and cholangitis. Stent occlusion is thought to be caused by bacterial adhesion and formation of biofilm. This study was carried out to assess whether treatment with ofloxacin in combination with ursodeoxycholic acid is superior to ursodeoxycholic acid alone in preventing stent occlusion. PATIENTS AND METHODS: Patients with obstructive jaundice due to inoperable malignant disease underwent placement of a straight 11.5-Fr polyethylene stent. After stent insertion, the patients were randomly assigned to receive either ofloxacin (200 mg b.i.d.) with ursodeoxycholic acid (250 mg t.i.d.) or ursodeoxycholic acid alone. The end points of the study were the frequency of stent occlusions, the time to stent occlusion, and the safety of the two regimens. RESULTS: Fifty-two patients were enrolled, of whom 26 were assigned to the combined therapy group and 26 to the control group. Thirty patients were suffering from pancreatic cancer, 13 from gallbladder or bile duct cancer, and nine had metastases from other malignant tumors. Eight stent occlusions (31%) occurred in the ofloxacin group and six (23 %) in the control group (P = 0.76). The mean times to stent occlusion were 95 +/- 9 days and 101 +/- 9 days, respectively (P = 0.91). No significant differences regarding survival time or safety were observed between the two groups. CONCLUSIONS: Ofloxacin in combination with ursodeoxycholic acid is not superior to ursodeoxycholic acid alone in preventing stent occlusion in patients with malignant obstructive jaundice.     

125I种子源组织间植入近距离治疗恶性肿瘤的疗效观察

目的：探讨Ⅰ^125种子源组织间植入近距离治疗恶性肿瘤的疗效。方法：采用Ⅰ^125种子源对71例各类恶性肿瘤患者进行组织间植入治疗，其中51例患者于术中将125Ⅰ种子源植入肿瘤切除后可能残留区域或不能切除的肿瘤组织内；20例患者在B超、CT引导下经皮穿刺将125Ⅰ种子源植入到肿瘤内，所有患者均获随访。结果：所有患者治疗后均恢复良好，主观症状明显改善，未发现与Ⅰ^125种子源植入相关的并发症。71患者血象虽较治疗前有所升高（P〈0.05），但仍在正常范围内，而免疫球蛋白水平变化不大（P〉0.05），各类患者相应肿瘤标志物水平在治疗后亦显著下降（P〈0．01）。71例患者治疗总有效率为87.3％，其中完全缓解12例（占16．9％）；部分缓解50例（占7（1．4％）；稳定7例（占9．8％）；进展2例（占2．8％）。结论：Ⅰ^125种子源组织间植入近距离治疗恶性肿瘤方法简便、安全，近期疗效确切，为恶性肿瘤的综合治疗提供了新的手段。     

自膨胀式支架在梗阻性黄疸治疗中的应用

目的　评价自膨胀式支架在梗阻性黄疸姑息性治疗中的价值。方法　我们对 18例梗阻性黄疸患者 ,实施了经皮肝穿 ,胆道内自膨胀式支架植入术。对其中 17例患者进行了 2～ 44周随访。结果　 18例内支架均成功植入 ,除 1例外 ,术后 2周内血清胆红素及碱性磷酸酶都显著降低 ,胆道梗阻引起的症状缓解。 3例 (17% )发生支架堵塞 ,平均支架通畅时间 18周。结论　自膨胀式内支架植入 ,是姑息性治疗梗阻性黄疸的安全有效手段。     

Early recurrence of obstructive jaundice after placement of a self-expanding metal endoprosthesis.

Self-expanding metal endoprostheses have ben used in the treatment of malignant obstructive jaundice for a few years. We report on a patient with obstructive jaundice due to a metastasis of a squamous cell lung cancer into the pancreatic head who received an expandable metal endoprosthesis and suffered recurrent jaundice and cholangitis after 38 days. On repeat ERCP, a very narrow stenosis was seen in the stent lumen caused by tumor ingrowth through the mesh. Intraluminal biopsies showed squamous cell carcinoma. A 10 Fr plastic endoprosthesis was inserted through the self-expanding stent with good drainage. On the basis of this experience, we feel that when faced with a patient with obstructive jaundice due to metastatic disease from a rapidly progressive carcinoma, the use of the currently available self-expanding metal endoprosthesis should be discouraged until the results of prospective studies with large numbers of patients have proven its superiority over the plastic endoprostheses. Meanwhile, modifications to prevent tumor ingrowth through the mesh of the stent are under investigation.