经皮经肝胆道镜治疗肝移植术后胆管铸型的安全性及其临床价值观察

目的评价经皮经肝胆道镜治疗肝移植术后胆管铸型的安全性及其临床价值。方法回顾2008年4月至2010年1月间采用经皮经肝胆道镜治疗的11例肝移植术后胆管铸型患者的临床资料,对治疗情况及随访结果进行分析总结。结果11例肝移植术后胆管铸型患者中,1例铸型分布于胆总管内,3例局限于右肝内胆管,4例局限于左肝内胆管,其余3例呈肝内外胆管弥漫分布。11例患者共接受了68例次的经皮经肝胆道镜治疗,其中10例（90．9％）治疗效果良好,肝功能示转氨酶、胆红素等值较治疗前明显降低,余1例因夹闭引流管后偶有发热,给予更换细管长期带管。无一例患者发生胆瘘以及难以控制的出血等严重并发症,只有1例治疗过程中发生瘘道部分断裂,所有患者术后随访10～30个月,1例在随访过程中因其他疾病死亡,其余患者状况良好。结论经皮经肝胆道镜治疗肝移植术后胆管铸型是一种安全、有效的方法,具有较好的应用价值,可在临床上推广应用。     

Intraductal ultrasonography combined with percutaneous transhepatic cholangioscopy for the preoperative evaluation of longitudinal tumor extent in hilar cholangiocarcinoma

Background and Aim: In hilar cholangiocarcinoma, an accurate assessment of preoperative resectability is important to optimize surgical resection. We investigated the accuracy of the combination of intraductal ultrasonography (IDUS) and percutaneous transhepatic cholangioscopy (PTCS) for evaluating longitudinal extent in hilar cholangiocarcinoma. Methods: Patients diagnosed with hilar cholangiocarcinoma underwent multidetector computed tomography (MDCT) and magnetic resonance cholangiography (MRC) for tumor staging and Bismuth type. Percutaneous transhepatic biliary drainage was performed at the left or right bile duct of the liver section that was anticipated to be preserved in the surgical treatment. After tract dilation, PTCS with cholangioscope‐directed biopsy and IDUS were sequentially performed to evaluate Bismuth type. Surgical treatment was executed according to tumor staging and longitudinal tumor extent. Postoperative histological Bismuth types were compared to preoperative Bismuth types based on MDCT, MRC, PTCS with biopsy, and IDUS. Results: From June 2006 to November 2008, 25 patients with hilar cholangiocarcinoma were enrolled, with 20 of these patients evaluable. The accuracy of MDCT, MRC, PTCS with biopsy, and IDUS for the evaluation of Bismuth type was 80%, 84.2%, 90%, and 85.0%, respectively, in 20 patients, and 82.4%, 82.4%, 94.1%, and 88.2%, respectively, in 18 patients with Bismuth type IIIa, IIIb, or IV cancer. The accuracy of the combination of IDUS and PTCS with biopsy was 95% in 20 patients, and 100% in 18 with Bismuth type IIIa, IIIb, or IV cancer. Conclusions: The combination of IDUS and PTCS with biopsy was highly accurate for assessing Bismuth type and may help in the identification of an optimal surgical plan for the treatment of hilar cholangiocarcinoma, especially in Bismuth type IIIa, IIIb, or IV.     

梗阻性黄疸患者经皮经肝胆管引流术后应用异甘草酸镁治疗肝损害的疗效观察

目的评价梗阻性黄疸患者经皮经肝胆管引流术(PTCD)后使用异甘草酸镁治疗肝功能损伤的临床疗效及安全性。方法选择2009年6月-2011年4月收治的梗阻性黄疸的患者共62例,在PTCD术后配合应用维生素B6、维生素C、复合辅酶静脉点滴的基础上,随机分为治疗组32例,加用异甘草酸镁100 mg;对照组30例,加用还原型谷胱甘肽1200 mg。治疗1周后,比较ALT、AST、Alb、GGT、ALP、TBil、DBil及肿瘤坏死因子(TNF)α、NF-κB的变化情况;观察与药物相关的不良反应。结果治疗1周后,治疗组与对照组TBil、DBil、ALT、AST、ALP、TNFα、NF-κB较治疗前均明显下降(P0.05);与对照组相比,治疗组TBil、DBil、ALT、AST、ALP、TNFα、NF-κB下降明显(P0.05);但对Alb、GGT的改善两组治疗前后比较及组间比较差异无统计学意义(P0.05)。结论梗阻性黄疸患者PTCD术后经异甘草酸镁治疗肝功能损伤对尽快恢复肝功能,消退黄疸,有促进作用,有更好的疗效和安全性。     

SpyGlass DS直视胆道镜系统在胆道疾病诊治中的初步临床研究(含视频）

目的 探讨SpyGlass DS直视胆道镜系统在胆道疾病诊治中的临床应用价值。方法 使用SpyGlass DS直视胆道镜系统对7例胆道疾病患者（包括3例胆总管巨大结石,4例不明原因胆管狭窄）进行镜下诊断和治疗。对胆总管巨大结石患者,行SpyGlass DS胆道镜直视下激光碎石,继之行常规ERCP取石;对不明原因胆管狭窄患者,在SpyGlass DS胆道镜直视下观察病变情况,必要时取活检。结果 7例患者均成功完成SpyGlass DS镜下诊治, SpyGlass DS平均操作时间12.6 min。3例胆总管巨大结石患者均成功完成碎石及取石,术后3 d鼻胆管造影显示无结石残留。4例胆管狭窄患者中,2例镜下诊断为恶性胆管狭窄,并被活检病理证实;另外2例镜下诊断为炎性狭窄,未取活检。术后2例患者出现高淀粉酶血症,均自行恢复正常。结论 SpyGlass DS能成功用于难治性胆管结石及不明原因胆管狭窄患者的诊治。