肝脏肿瘤动脉栓塞化疗术后胆管狭窄

目的 分析肝脏经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法.方法 回顾性分析1994年6月至2010年3月在浙江省人民医院及上海交通大学医学院附属新华医院行肝脏TACE治疗后出现胆管狭窄的15例患者的临床资料.7例为原发性肝癌,5例为肝脏血管瘤,3例为转移性肝癌,原发疾病分别为结肠癌2例和胰腺癌1例.肝脏TACE后出现梗阻性黄疸的时间为5～16个月,中位时间为9个月.结果 15例胆管狭窄病例均出现不同程度的梗阻性黄疸,13例经外科手术或经皮肝穿刺胆管造影(percutaneous transhepatic cholangiography,PTC)+放置胆管支架,2例仅行经皮肝穿刺胆道引流(percutaneous transhepatic cholangial drainage,PTCD).术后梗阻性黄疸均获得明显缓解.5例肝血管瘤状况良好;2例原发性肝癌TACE后梗阻性黄疸随访2年,无胆管梗阻再发和肿瘤复发;其余8例随访3～18个月,均死于原发病恶化.结论手术或介入手段治疗肝脏TACE术后胆管狭窄致梗阻性黄疸可获得良好的治疗效果,应根据原发病和胆管梗阻的部位、范围决定治疗方式.     

肝脏肿瘤动脉栓塞化疗术后胆管狭窄

目的 分析肝脏经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法.方法 回顾性分析1994年6月至2010年3月在浙江省人民医院及上海交通大学医学院附属新华医院行肝脏TACE治疗后出现胆管狭窄的15例患者的临床资料.7例为原发性肝癌,5例为肝脏血管瘤,3例为转移性肝癌,原发疾病分别为结肠癌2例和胰腺癌1例.肝脏TACE后出现梗阻性黄疸的时间为5～16个月,中位时间为9个月.结果 15例胆管狭窄病例均出现不同程度的梗阻性黄疸,13例经外科手术或经皮肝穿刺胆管造影(percutaneous transhepatic cholangiography,PTC)+放置胆管支架,2例仅行经皮肝穿刺胆道引流(percutaneous transhepatic cholangial drainage,PTCD).术后梗阻性黄疸均获得明显缓解.5例肝血管瘤状况良好;2例原发性肝癌TACE后梗阻性黄疸随访2年,无胆管梗阻再发和肿瘤复发;其余8例随访3～18个月,均死于原发病恶化.结论手术或介入手段治疗肝脏TACE术后胆管狭窄致梗阻性黄疸可获得良好的治疗效果,应根据原发病和胆管梗阻的部位、范围决定治疗方式.     

阻塞性黄疸术前经皮肝穿刺胆管引流对围手术期的影响

【Abstract】〓Objective〓To summarize the experience in treatment of the obstructive jaundice by preoperative percutaneous puncture of liver bile duct drainage. Methods〓Eight-six patients with obstructive jaundice were included and divided into two groups according to the operation procedure, 44 cases were given preoperative percutaneous transhepatic cholangial drainage(observation group) and then,.underwent internal or external drainage or radical operation,.42 cases were served as control group without preoperative percutaneous transhepatic cholangial drainage..Intraoperative blood loss, operative time,..hospital stay and complications were compared between two groups. The preoperative and postoperative liver function tests,such as total bilirubin(TB),.serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) were evaluated and compared in two groups. Results〓The operation time,.blood loss,.length of hospital stay and complication rates between observation group were lower than that in control group (P<0.05). The levels of TB, ALT, AST in 14 days after operation reduced in two groups, but were significantly decreased in observation group,.as compared to control group (P<0.05). Conclusion〓For patients with obstructive jaundice, preoperative percutaneous transhepatic cholangial drainage would shorten the length of hospital stay,.reduce complications occurrence,.and improve liver function.     

胆道数字成像技术在活体肝移植肝内胆道解剖分型及胆道切面确定中的应用

Objective To evaluate biliary digital imaging technology in determining the type of the intrahepatic bile duct anatomy and the transection plane of the duct in right lobe living donor liver transplantation(LDLT). Methods Mobile digital subtraction angiography was performed to show the intrahepatic bile duct anatomy of 66 liver transplant donor candidates. Combined with metal markers, the bile duct transection plane was defined. Comparing with the actual results, the effect of digital imaging technology in determining the intrahepatic anatomical variations and transection plane of the duct in LDLT was evaluated. Results Intrahepatic bile duct anatomical variations were showed in all donors by using digital imaging technology. type Ⅰ (classical type) was identified in45 cases (68.2%), type Ⅱ (with triple confluence, the simultaneous emptying of the right anterior segmental duct, right posterior segmental duct and left hepatic duct into the common hepatic duct) in 7 cases ( 10.6% ), type Ⅲ (no right hepatic duct stem, right posterior segmental duct draining into common hepatic duct) in 13 cases ( 19. 7% ), type Ⅳ (no right hepatic duct stem, right posterior segmental duct draining into left hepatic duct) in 1 case (1.5%), and type Ⅴ (complex variation ) in no case (0%). As a result, cases of type Ⅰ form a single anastomosis. In type Ⅱ, four cases formed double anastomoses, three cases formed single anastomosis with or without ductoplasty. In type Ⅲ, two anastomoses were formed in 9 cases, single anastomosis in 4 cases with ductoplasty. The case of type Ⅳ had double anastomoses. In all cases right lobe liver were harvested.Conclusions Biliary digital subtraction image combined with metal markers accurately defines intrahepatic bile duct anatomy and the transection plane, helping to reduce number of bile duct anastomosis, and contributes to safe graft harvesting.     

胆道数字成像技术在活体肝移植肝内胆道解剖分型及胆道切面确定中的应用

Objective To evaluate biliary digital imaging technology in determining the type of the intrahepatic bile duct anatomy and the transection plane of the duct in right lobe living donor liver transplantation(LDLT). Methods Mobile digital subtraction angiography was performed to show the intrahepatic bile duct anatomy of 66 liver transplant donor candidates. Combined with metal markers, the bile duct transection plane was defined. Comparing with the actual results, the effect of digital imaging technology in determining the intrahepatic anatomical variations and transection plane of the duct in LDLT was evaluated. Results Intrahepatic bile duct anatomical variations were showed in all donors by using digital imaging technology. type Ⅰ (classical type) was identified in45 cases (68.2%), type Ⅱ (with triple confluence, the simultaneous emptying of the right anterior segmental duct, right posterior segmental duct and left hepatic duct into the common hepatic duct) in 7 cases ( 10.6% ), type Ⅲ (no right hepatic duct stem, right posterior segmental duct draining into common hepatic duct) in 13 cases ( 19. 7% ), type Ⅳ (no right hepatic duct stem, right posterior segmental duct draining into left hepatic duct) in 1 case (1.5%), and type Ⅴ (complex variation ) in no case (0%). As a result, cases of type Ⅰ form a single anastomosis. In type Ⅱ, four cases formed double anastomoses, three cases formed single anastomosis with or without ductoplasty. In type Ⅲ, two anastomoses were formed in 9 cases, single anastomosis in 4 cases with ductoplasty. The case of type Ⅳ had double anastomoses. In all cases right lobe liver were harvested.Conclusions Biliary digital subtraction image combined with metal markers accurately defines intrahepatic bile duct anatomy and the transection plane, helping to reduce number of bile duct anastomosis, and contributes to safe graft harvesting.     

梗阻性黄疸患者mtDNA损伤缺失及突变分析

目的 对梗阻性黄疸患者mtDNA片段的缺失及突变进行分析,为探讨mtDNA缺失及突变在胆汁淤积性肝损伤的作用机制打下基础.方法 严格按照入组条件随机选取梗阻性黄疸患者30例(病例组)和对照组10例,利用17对相互错配重叠的引物进行PCR扩增,并结合大量基因测序结果对梗阻性黄疸患者肝细胞mtDNA的损伤缺失情况进行初步定位.结果 梗阻性黄疸患者肝部分细胞mtDNA分别出现8429～9591约1.1 kb,16024～60约0.6 kb、1889～3031约1.1 kb的片段缺失和4977 bp片段的共同缺失,以及D-loop区的部分碱基的高突变.结论 梗阻性黄疸患者mtDNA存在多片段缺失及多点突变.

Abstract：

Objective To lay the foundation for analyzing the mechanism of liver cell injury caused by mtDNA deletion and mutation in patients with obstructive jaundice. Methods 30 patients were randomly selected as obstructive jaundice group (case group) and 10 patients as control group according to the strict condition. Author makes use of the methods of PCR amplification of the entire human mitochondrial genome in 17 mismatch-specific overlapping fragments and gene sequencing results to Preliminary estimate the localizathion of hepatocyte mtDNA damage in patients with obstructive jaundice. Result Deletions and length of partial liver cells were 8429-9591 of about 1. 1 kb, 16024-60 of about 0. 6 kb, 1889-3031 of about 1. 1 kb and 4977bps common deletion and the high mutation rate of some bases in D-loop region. Conclusion There are multiple mtDNA deletions and multiple point mutations in patients with obstructive jaundice     

大鼠肝脏胆管及门静脉铸型扫描图像分析

目的 建立大鼠去胆管肝叶和去门静脉肝叶自身对照模型,观察两肝叶之间胆管及门静脉是否存在交通支及其大体形态变化.方法 SD大鼠40只,分为S、BL、PL和BPL共4组,分别应用氰基丙烯酸酯对肝右叶胆管进行栓塞结扎制备去胆管肝叶;对肝方叶行门静脉结扎制备去门静脉肝叶.通过测量肝重/体重和方叶重/右叶重及对各组大鼠胆管和门静脉分别灌注硫酸钡明胶混悬液制备铸型标本,并运用Micro-CT扫描来观察两叶肝脏胆道和门静脉形态变化.结果 (1)大鼠手术后在本观察期内存活率达到100%,无黄疸表现.肝叶大体形态观察和两叶肝重量比指标显示,S、BL、PL组肝重/体重为3.5%,与BPL组比较差异有统计学意义(P<0.01).S、BL组方叶/右叶重量比为60%～70%,PL及BPL组则为20%左右,提示去胆管和去门脉肝叶之间的重量比差异有统计学意义(P<0.05或P<0.01).(2)Micro-CT铸型扫描可以直观地显示胆管和门静脉形态变化,未发现两个肝叶之间存在交通支或侧枝循环.结论 去胆管肝叶无明显萎缩.胆管及门静脉灌注造影显示两叶胆管及门静脉无明显的侧枝循环.Micro-CT扫描可以直观地显示胆管及门静脉形态变化,硫酸钡明胶灌注铸型为小动物肝脏Glissons系统形态学研究提供了一种借鉴方法.

Abstract：

Objective To establish a rat self-control model with the bile duct deprived (BDD) and the portal vein deprived (PVD) hepatic lobe and to observe whether there were communicated branches between the two lobes.Methods Forty SD rats were divided into four groups: group S with sham operation as an undisposed blank control, group BL with the right lobe bile duct embolized and ligated, group PL with the quadrate lobe portal vein ligated, and group BPL with the right lobe bile duct embolized and ligated and meanwhile the quadrate lobe portal vein ligated. The right hepatic bile ducts were embolized with cyanoacrylate and then ligated to prepare the BDD lobe. The portal vein of quadrate hepatic lobes was ligated as the PVD lobes. The observation period was 1 month after the bile duct or portal vein ligated. The values of liver weight/body weight and the quadrate lobe weight/the right lobe weight were recorded. The bile duct and portal vein casting specimens of these four groups were prepared by a perfusion with barium and gelatin solution. Three-dimensional micro-computerized tomography (Micro-CT) data sets were acquired to observe the morphological changes of bile duct and portal vein of the livers and whether there were communicated branches between the right and quadrate lobes in order to estimate the feasibility of the model.Results (1) The survival rate of rats after operation was 100%. No jaundice was observed. The ratio of liver/body weight in groups S, BL and PL was about 3.5%, significantly lower than that in group BPL (P<0.01). The ratio of quadrate/right lobe weight in groups S and BL was about 60%-70%, while that was about 20% in groups PL and BPL (P<0.05, or P<0.01); (2) Micro-CT images exhibited directly the morphological changes of the hepatic bile duct and portal vein, and no communicated branches or side circulation situation were observed between the two lobes.Conclusion No collateral branches were found between the two lobes and the model was successfully established. The barium casting liver specimen scanned by micro-CT provided a useful method for the morphological observation of rat liver Glissons system.     

十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石

Objective To summarize the curative effect of three-dimensional spiral CT cholangiography combined with endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST)and laparoscopic cholecystectomy(LC)for treatment of patients with cholelithiasts concurrent with choledocholithiasis.Methods A retrospective analysis was carried out for 30 cases of cholelithiasts concurrent with choledocholithiasis which were treated with ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy from July 2007 to June 2009.And the post operation parameters were compared with those of 36 patients who received traditional operation from July 2005 to June 2007.Results All the procedures were successfully accomplished.Complication occurred in 2 cases.both with mild acute pancreatitis.With the three-dimensional spiral CT cholangiography,the intra-hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100 percent patients,and choleeyst bile duct was visible in 73%patients,and three-dimensional spiral CT cholangiography can tell the position of cholecyst duct,then can decrease the possibility of damage of bile duct.The gastrointestinal function recovery time and feeding time after operation,the in hospital time after operation in the ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy group were superior to those of the traditional operation patients(P＜0.05).Conclusion ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for treatment of patients with cholelithiasts concurrent with choledocholithiasis is safe,with less trauma and fast recover after operation and Can decrease the possibility of damaging bile duct,which can be used widely.     

Topical nitrate drip infusion using cystic duct tube for retained bile duct stone:A six patients case series

A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy(EST),followed by stone extraction,are usually an effective treatment for this condition.However,these procedures are associated with severe complications including pancreatitis,bleeding,and duodenal perforation.Nitrates such as glyceryl trinitrate(GTN) and isosorbide dinitrate(ISDN) are known to relax the sphincter of Oddi.In 6 cases in which a retained stone was detected following cholecystectomy,topical nitrate drip infusion via cystic duct tube(C-tube) was carried out.Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN,which was the regular dose of intravenous injection.Three other cases failed,and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed.One patient developed an adverse event of nausea.Severe complications were not observed.We consider the topical nitrate drip infusion via C-tube to be old but safe,easy,and inexpensive procedure for retained bile duct stone following cholecystectomy,inasmuch as removal rate was about 50% in our cases.     

家犬梗阻型胆道损伤外科修复时机的探讨

目的 探讨实验性梗阻性胆道损伤后手术修复的时机.方法 将60只健康家犬制成梗阻性胆管损伤的动物模型,随机分为5组(n=12),分别为梗阻5 d,梗阻10 d,梗阻15 d、梗阻20 d和梗阻30 d组,对照组为模型建立之前的正常犬.动态观察梗阻损伤后不同时间段的胆管形态学、局部组织病理学及肝脏功能变化指标,并于各组获得组织标本后即刻行胆肠Roux-en-Y吻合修复胆道,观察胆道梗阻性损伤修复术后犬并发症及生存情况.数据采用单因素方差分析进行分析.结果 胆管梗阻性损伤后,近端梗阻胆管持续扩张,第10天达(15.6±1.7)mm;损伤胆管局部组织出现急性炎症反应,以梗阻5 d时最严重(HE染色、WBC计数54±6个),梗阻第15天时炎症消退明显(HE染色、WBC计数42±7 vs 54±6个,P＜0.05),同时胆管壁由早期(第5天)的炎性水肿样增厚,改变成纤维增生性增厚(第15天);在梗阻性黄疸状态下肝功能发生规律性生理改变,血清TBIL、DBIL和ALP值在阻塞5 d组最高,至梗阻30 d时急剧上升(P＜0.05);而酶学指标ALT和AST在迅速升高后,在梗阻20 d后下降(P＜0.05),表现为"胆酶分离"现象;其中57只犬成功经受胆道修复手术,10只犬术后10 d内因胆漏死亡,其中损伤10 d内修复的胆漏7只,损伤10 d后修复的胆漏3只(P=0.025),术后观察发现,梗阻性损伤后3个月内营养及脏器衰竭死亡13例,其中梗阻5 d和梗阻10 d组各1例,梗阻15 d和20 d组各2例,梗阻30 d组7例(P＜0.05).结论 胆道梗阻后10～20 d机体处于代偿期,且炎性水肿减轻明显,手术操作难度较小,此时行手术修复,胆漏发生率和器官衰竭率较低,手术容易获得良好效果.

Abstract：

Objective To explore the optimal timing of operation for experimental obstructive jaundice in a dog model. Method A dog model of bile duct stricture (BDS) was established. Dogs were divided into (n = 12 in each group) 6 groups, ie control, BDS days 5, 10, 15, 20, and 30. In each dog,the morphology and local histopathology of the bile duct, and the liver function in different periods were observed. At the time of surgery biopsy was taken and Roux-en-Y hepaticojejunostomy performed. Surgical complications and survival were evaluated. Result After bile duct obstruction, the proximal bile duct dilated continuously. The diameter of bile duct was 15.6 ± 1.7 mm at the 10th day. The injury bile ductshowed the acute inflammation change. In the early time (in 10 days), inflammatory cells increased in the tissues, mucous edema aggravated, the wall was edematous thickening, it was most severe ( WBC counting 54 ±6) in the 5th day. In the later period (10 -30 days), inflammatory cells reduced, bile duct wall became fibrosis, which was most obvious in the 15th day (42 ± 7 vs 54 ± 6, P ＜ 0.05 ). During the development of jaundice, serum bilirubin reached the highest level in the early period ( BDS days 5 group),then presented a platform time, and then rised extremely at the last stage of the experiment ( BDS day 30 group) . Changes of ALT and AST paralleled that of bilirubin before the 20th day of obstruction and then plummeted. BDS was repaired successfully in 57 dogs. Ten dogs died postoperatively due to bile leakage within 10 days, 3 dogs in BDS days 5 group (3/11), 4 in BDS days 10 group (4/12), one each in other groups. Postoperatively 13 BDS dogs died of malnutrition and organ failure within 3 months, including one each in days 5 and days 10 group, two each in days 15 and days 20 group, and 7 in days 30 group (P＜0. 05). Conclusion Considering the changes of morphology, physical function and result of follow up.The period between 10 and 20 days after acute bile duct injury is optimal for surgical repair.     

原发性肝癌插管栓塞化疗后胆管癌栓的诊治

目的探讨原发性肝癌介入治疗后出现胆管癌栓的诊断和治疗。方法回顾性总结分析3年来收治的12例患者的临床资料。结果12例患者于介入治疗后3~5天突然出现皮肤巩膜黄染,8例B超提示肝内外胆管扩张,胆总管内絮状回声。全部患者均行ERCP检查确诊,7例内镜下胆总管内癌栓完全取净,未放置胆道引流,另5例放置胆道引流管,全部患者均恢复出院,4例患者随访1.5年仍带瘤生存。结论原发性肝癌介入治疗后胆管癌栓脱落引起梗阻性黄疸不少见,诊断应与肝功能衰竭鉴别,治疗首选内镜下胆管取癌栓和/或胆道置管引流。     

胆道支架联合PTCD对恶性梗阻性黄疸患者肝功能与生活质量的影响研究

目的研究胆道支架联合PTCD对恶性梗阻性黄疸患者肝功能与生活质量的影响。方法随机选取2006年4月至2016年4月期间在我院肝胆外科就诊的恶性梗阻性黄疸的患者216例为研究对象,均采用胆道支架联合PTCD治疗,分析患者胆管狭窄部位及原因,术前3d、术后3d、7d和14d肝功能指标:白蛋白、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素,术后并发症及随访结果,对术前感染、肝功能评分和术后针对肿瘤治疗进行多因素COX模型回归分析,采用SPSS20.0统计学软件进分析。结果 (1)肝管癌患者有87例,其中,胆总管60例,肝门部胆管12例,左右肝管15例;胰腺癌患者有35例,狭窄原因为胆总管;肝癌患者有25例,其中,胆总管11例,肝门部胆管6例,多部位8例;壶腹周围癌患者有30例,狭窄原因为胆总管;胃癌肝转移患者有39例,其中,肝门部胆管23例,多部位16例。(2)术后3d、7d和14d的白蛋白、碱性磷酸酶、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素含量水平均低于术前,术前后的比较有统计学差异(P0.05);随着术后时间的延长,白蛋白、碱性磷酸酶、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素含量水平逐渐降低,趋于正常值范围。(3)胆道感染的患者有17例,发生率为7.87%;急性胰腺炎的患者有21例,发生率为9.72%;支架脱落移位的患者有6例,发生率为2.78%;本组216例患者获访,随访时间为8d-120个月,平均每3个月随访一次,随访期间,有171例患者死亡,均死于肿瘤进展及多脏器功能衰竭,45例患者至随访截止时无黄疸加重症状。(4)术前感染、肝功能评分和术后针对肿瘤治疗是恶性梗阻性黄疸发生的独立因素(P0.05)。结论胆道支架联合PTCD是恶性梗阻性黄疸治疗的有效方法,能提高患者肝功能和改善生活质量,延长生存期。     

原发性肝癌合并阻塞性黄疸的诊断和治疗

目的 探讨原发性肝癌合并阻塞性黄疸的诊断与治疗。方法 自1996年10月至2002年12月间我院收治原发性肝癌合并阻塞性黄疸70例,分成积极治疗组(n=61)和对症处理组(n=9);积极治疗组再分为单纯胆道引流组(n=43)和综合治疗组(n=18)。积极治疗组接受胆道引流、手术和肝动脉化疗栓塞等治疗。随访所有病人的生存时间。结果 随访50例,随访率71.4％。积极治疗组和对症处理组平均生存时间分别为9.6个月和2.3个月,相差显著(t’=3.45,P<0.05)。综合治疗组和单纯胆道引流组平均生存时间分别为21.9个月和4.1个月,相差显著(t’=4.11,P<0.05)。结论 原发性肝癌合并阻塞性黄疸的病人如能及时解除黄疸,积极治疗肿瘤,仍可显著延长病人生命。     

肝脏转移性肿瘤动脉化疗栓塞术后的重度缺血性胆道损伤:附六例

目的 研究和探讨动脉化疗栓塞(TACE)治疗肝脏转移性肿瘤时造成的胆道损伤的原因以及治疗和预防.方法 2001-2006年,笔者对6例因反复TACE引起的胆道损伤的肝脏转移性肿瘤病人的临床及影像资料进行了回顾性分析.结果 6例病人接受了数次TACE治疗后的2周至2个月内均出现了严重的胆道损伤,影像表现主要为局限或多发的肝管扩张、胆汁瘤形成、损伤区肝实质萎缩.结论 TACE治疗少动脉血供的转移性肝脏肿瘤时可导致严重的胆道缺血性损伤,对此类肿瘤的介入治疗要慎重.     

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目的 探讨不同类型原发性肝癌伴梗阻性黄疸的原因及其治疗方法。方法 分析原发性肝癌伴梗阻性黄疸的病人15例。其中肝癌引起胆管癌栓7例。肝癌压迫或侵犯肝门部胆管8例。其中手术10例，清除肝癌原发灶，解除胆管梗阻，非手术5例，先行减轻黄疸处理，然后行TAE，PEI等综合治疗。结果 手术切除病灶，延长生存期，而非手术处理组也明显改善症状，疗效显著，随访1-24个月（平均9个月）3例死亡，12例仍存活。结论 临床上有必要对原发性肝癌伴梗阻性黄疸进行积极治疗，以改善生活质量，延长生存期。     

PTCD治疗梗阻性黄疸137例分析

目的PTCD技术应用及临床价值,旨在提高成功率,减少并发症。方法对患胆结石、胆囊癌、胆管癌、肝转移癌引起的阻塞性黄疸137例患者在彩超引导下行PTCD,置管147根,合适胆管选择左肝高于右肝。结果1次穿刺成功率98．58％,2次成功率100％。引导管放置时间3—186d,发生并发症6例,占4．4％。结论彩超引导下PTCD是目前最为简便、安全、实用的胆道减压方法。     

超声引导下经皮肝穿刺胆管引流术治疗阻塞性黄疸的临床价值

目的探讨超声引导下经皮经肝穿刺胆管引流术（PTCD）治疗阻塞性黄疸的临床应用价值。方法回顾性分析PTCD治疗149例阻塞性黄疸患者的成功率与并发症,其中胆管癌60例,胆管结石35例,胰头癌28例,手术后胆管狭窄8例,急性化脓性胆管炎6例,胆囊癌7例,壶腹周围癌3例,胰体癌2例。结果146例穿刺成功（146／149,97．99％）,其中经肝左叶肝内胆管置管104例,经肝右叶肝内胆管置管34例,肝左叶及肝右叶肝内胆管均置管8例。3例穿刺失败,均为胆管癌（3／149,2．01％）,其中2例因肝内胆管内径纤细、穿刺路径过深而无法成功植入引流管;1例因穿刺胆管持续出血而被迫终止手术。穿刺术后随访1周～18个月,除3例患者出现引流管脱出、1例胆管感染外,其余病例均引流通畅,无明显并发症。结论彩色多普勒超声引导下PTCD治疗阻塞性黄疸操作简便,安全、有效。     

原发性肝癌伴胆管癌栓致阻塞性黄疸的外科治疗

目的探讨原发性肝癌伴胆管癌栓致阻塞性黄疸的外科手术治疗及其治疗效果。方法回顾性对15例原发性肝癌伴胆管癌栓致阻塞性黄疸行外科手术治疗的总结和分析。结果行左半肝切除 胆总管切开取癌栓术5例,行肿瘤切除 胆总管切开取癌栓术7例,行胆总管切开取癌栓 肝总动脉结扎3例,术后随访2年,平均生存时间为14.5个月,最长存活23个月。结论外科治疗明显提高了患者生活质量,延长了生存时间。