胆管引流术与胆管支架置入术治疗恶性阻塞性黄疸的临床疗效比较

Objective To summarize and compare the short-term and long-term clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic biliary stent (PTBS) in the treatment of malignant obstructive jaundice. Methods 210 cases of malignant obstructive jaundice underwent interventionsl therapy, of which 161 cases of drainage catheters placement and 49 cases of metalic stent implantation.Follow-up information was obtained through telephone review or check-up records. Results The technical success rate of technique was 100%. At 3-5 days after treatment, the serum total bilirubin in 15 metalic stent-treated patients was decreased by (178. 04 ± 42. 32) μmol/L, and direct bilirubin by (83. 97 ± 23. 63) μmol/L.Compared with those of 28 cases treted with drainage catheters: (95.67 ± 34. 28) μmol/L and (49. 84 ± 28. 21) μmol/L, there were statistically significant differences between the two groups (P =0.017 and P= 0.035). At 6-9 days after treatment, the serum total bilirubin in 28 cases of metalic stent group was decreased by (188. 22 ± 79. 90) μmol/L,and that in 126 cases of drainage catheter group decreased by (141. 39 ± 65. 32) μmol/L The difference was statistically significant (P =0.014). But the decline value of direct bilirubin had no significant difference. The median patency period and the median survival time of the drainage catheter group were 60 and 148 days, respectively,those of metalic stent group were 197 days and 245 days. There were statistically significant differences between the two groups ( P <0.05). Conclusion The results of this study indicate that the short-term and long-term efficacies of metalic stent implantation are better than those of catheter drainage technique.     

胆管引流术与胆管支架置入术治疗恶性阻塞性黄疸的临床疗效比较

Objective To summarize and compare the short-term and long-term clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic biliary stent (PTBS) in the treatment of malignant obstructive jaundice. Methods 210 cases of malignant obstructive jaundice underwent interventionsl therapy, of which 161 cases of drainage catheters placement and 49 cases of metalic stent implantation.Follow-up information was obtained through telephone review or check-up records. Results The technical success rate of technique was 100%. At 3-5 days after treatment, the serum total bilirubin in 15 metalic stent-treated patients was decreased by (178. 04 ± 42. 32) μmol/L, and direct bilirubin by (83. 97 ± 23. 63) μmol/L.Compared with those of 28 cases treted with drainage catheters: (95.67 ± 34. 28) μmol/L and (49. 84 ± 28. 21) μmol/L, there were statistically significant differences between the two groups (P =0.017 and P= 0.035). At 6-9 days after treatment, the serum total bilirubin in 28 cases of metalic stent group was decreased by (188. 22 ± 79. 90) μmol/L,and that in 126 cases of drainage catheter group decreased by (141. 39 ± 65. 32) μmol/L The difference was statistically significant (P =0.014). But the decline value of direct bilirubin had no significant difference. The median patency period and the median survival time of the drainage catheter group were 60 and 148 days, respectively,those of metalic stent group were 197 days and 245 days. There were statistically significant differences between the two groups ( P <0.05). Conclusion The results of this study indicate that the short-term and long-term efficacies of metalic stent implantation are better than those of catheter drainage technique.     

Pancreatic cancer–Palliative therapy: stenting

Pancreatic cancer remains a common and very lethal malignancy with a median survival of approximately 6 months. Surgical resection offers the only potentially curative approach but many patients (80% or more) are ineligible for this kind of therapy, because of age, comorbidities, or locally advanced or metastatic disease that does not benefit from resection. Thus, for many patients with pancreatic cancer treatment remains palliative and endoscopic therapy to relieve bile duct or gastric outlet obstruction becomes of special importance. Although both surgical and non surgical palliative procedures can relieve biliary and duodenal obstruction particularly endoscopic treatment with plastic prostheses or self expanding metal stents was shown to be not only highly effective but also to be burdened with only few complications. The present article summarizes the palliative endoscopic treatment in patients with non resectable pancreatic cancer.     

胰腺癌:姑息性支架术治疗

Pancreatic cancer remains a common and very lethal malignancy with a median survival of approximately 6 months. Surgical resection offers the only potentially curative approach but many patients （80% or more） are ineligible for this kind of therapy, because of age, comorbidities, or locally advanced or metastatic disease that does not benefit from resection. Thus, for many patients with pancreatic cancer treatment remains palliative and endoscopic therapy to relieve bile duct or gastric outlet obstruction becomes of special importance. Although both surgical and non surgical palliative procedures can relieve biliary and duodenal obstruction particularly endoscopic treatment with plastic prostheses or self expanding metal stents was shown to be not only highly effective but also to be burdened with only few complications. The present article summarizes the palliative endoscopic treatment in patients with non resectable pancreatic cancer.     

肝部分切除与肝十二指肠韧带骨髂化治疗肝门部胆管癌

Objective To summarize the surgical experience of partial hepatectomy with skeletonization of the hepatoduodenal ligament in the treatment of hilar cholangiocarcinoma.Methods Between Jan.1999 and Dec,2001,67 consecutive patients with hilar cholangiocarcinoma underwent surgical exploration at the Second Military Medical University,Eastern Hepatobiliary Surgery Hospital.The clinical data of these patients were reviewed.Results Of the 67 patients,65(97%) underwent surgical resection.Fourty-nine patients(73%) received curative resection:22 skeletonization resection(SR) and 27 SR combined with partial hepatectomy.In 16 patients(9%) with curative resection the tumor margin was histologically postive and the resection was therefore considered palliative.The tumors were classified according to Bismuth with SR was type Ⅱ(17cases),various types of partial hepatectomy with SR was type Ⅲ and type IV.Right lobectomy with right caudate lobectomy was indicated in type Ⅲ(6cases),left lobectomy with complete caudate lobectomy in type Ⅲb(15cases),right loobectomy with complete caudate lobectomy(3 cases),left lobectomy with complete caudate lobectomy(9 cases) and quadrate lobectomy(2 cases)in type IV.SR and left lobectomy with complete caudate lobectomy was successfully performed in 2 patients(3%) who had undergone palliative biliary resection and cholangiojejunostomy before.Eight patients(12%) had local resecton of the tumor with Roux-en-Y hepaticojejunostomy reconstruction using intrahepatic stents.Two patients(3%) had palliative biliary drainage.Combined portal vein resection was performed in 13 patients(20%) and hepatic artery resection in 27 patients(40%) .Twenty-four atients(36%) had no postoperative complication,23 patients(34%) had minor complications only ,and the remaining 20 patients(30%) had major complications.Of the 20 patients with major complications,14 recovered,the remaining 6 patients died from hepatorenal failure with other organ failures,from myocardial infarction or from intraabdominal or gastrointestianl bleeding 7,12,14,42,57 or 89 days after surgery.The 30-day operative mortality was 4.5%.The mean survival of the patient with curative resecton was 16 months(range 1-32 months);for those undergong palliative resection mean survival was 7 months(range 1-14months).Conlusion Partial hepatectomy with SR for hilar cholangiocarcinoma can be performed with acceptable morbidity and mortality.For curative treatmet of hilar cholangiocarcinoma,caudate lobectomy is always recommended in Bismuth Ⅲ/IV.     

Value of ^18F-FDG PET in Clinical Staging of Non-Small Cell Lung Cancer

OBJECTIVE To evaluate the feasibility of ^18F-deoxyglucose positron emission tomography (^18F-FDG PET) in the staging of non-small cell lung cancer(NSCLC). METHODS 105 patients with NSCLC had been examined by ^18F-FDG PET before radiotherapy. The results of the ^18F-FDG PET examination were compared with those of CT.RESULTS The staging was changed in 38 patients because of ^18F-FDG PET findings, with PET resulting in upstaging in 31 patients and downstaging in seven patients. Because of distant metastasis detected by PET, 21 patients received palliative treatment. Six of the seven downstaged patients underwent radical surgery, among which the PET findings were concordant with the pathological findings in five patients. Distant metastasis detected by PET elevated the pre-PET stage: at stage 110.0% (2/20), stage Ⅱ 14.3% (3/21) and stage Ⅲ 25.0% (16/64), respectively.CONCLUSION ^18F-FDG PET, by changing clinical staging in 36.2% (38/105) of NSCLC patients, has an impact on treatment strategy in NSCLC patients.     

Treatment of Non-Small Cell Lung Cancer （NSCLC） Using CT in Combination with a PET Examination to Minimize the Clinical Target Volume of the Mediastinum

OBJECTIVE To decrease radiation injury of the esophagus and lungs by utilizing a CT scan in combination with PET tumor imaging in order to minimize the clinical target area of locally advanced non-small cell lung can-cer, without preventive radiation on the lymphatic drainage area. METHODS Of 76 patients with locally advanced non-small cell lung cancer (NSCLC), 32 received a PET examination before radiotherapy. Preventive radiation was not conducted in the mediastinum area without lymphatic metastasis, which was confirmed by CT and PET. For the other 44 patients, preventive radiation was performed in the lymphatic drainage area. PET examinations showed that the clinical target volume of the patients was decreased on average to about one third. The radiation therapy for patients of the two groups was the same, i.e. the dose for accelerated fractionated irradiation was 3 Gy/time and 5 time/week. The preventive dose was 42 to 45 Gy/time, 14 to 15 time/week, with 3-week treatment, and the therapeu- tic dose was 60 to 63 Gy/time, 20 to 21 time/week, with a period of 4 to 5 weeks. RESULTS The rate of missed lymph nodes beyond the irradiation field was 6.3% and 4.5% respectively in the group with and without PET exami- nation (P = 0.831). The incidence of acute radioactive esophagitis was 15.6 % and 45.5% in the two groups respectively (P = 0.006). The incidence of acute radiation pneumonia and long-term pulmonary fibrosis in the two groups was 6.3% and 9.1%, and 68.8% and 75.0%, respectively (P = 0.982 and P = 0.547). CONCLUSION The recurrence rate in the lymph nodes beyond the tar-get area was not increased after minimizing the clinical target volume (CTV), whereas radioactive injury to the lungs and esophageal injury was reduced, and especially with a significant decrease in the rate of acute radioactive esophagitis. The method of CT in combination with PET for minimizing the mediastinal CTV is superior to the conventional preventive radiation of the mediastinum.     

A multicenter,retrospective epidemiologic survey of the clinical features and management of bone metastatic disease in China

Background: Bone metastases are common in patients with advanced cancer. Bisphosphonates (BPs) could prevent or delay the development of skeleton-related events (SREs). The present study aimed to identify the clinical features of and treatment strategies for Chinese patients with bone metastases. Methods: Consecutive cancer patients who had bone metastases and received BP treatment were enrolled. A ques-tionnaire was developed to collect the patients’clinical data, as well as information on the diagnosis and manage-ment of bone metastases. Physicians’awareness of the guidelines and knowledge of the application of BP were also assessed. Results: A total of 3223 patients with lung cancer (36.5%), breast cancer (30.9%), prostate cancer (8.5%), and gas-trointestinal cancer (5.7%) were included in this study. The sites of bone metastases were the thoracic spine (56.0 %), lumbar spine (47.1%), ribs (32.6%), and pelvis (23.2%). The SRE frequency was the highest in patients with multiple myeloma (36.6%), followed by those with lung cancer (25.9%), breast cancer (20.2%), prostate cancer (18.2%), and gas-trointestinal cancer (17.3%). Irradiation to the bone was the most frequent SRE (58% in lung cancer patients, 45% in breast cancer patients, and 48% in prostate cancer patients). Our survey also showed that 45.5% of patients received BP within 3 months after their diagnosis of bone metastases, whereas the remaining 54.5% of patients did not receive BP treatment until at least 3 months after their diagnosis of bone metastases. The SRE frequency in the former group was significantly lower than that in the latter group (4.0% vs. 42.3%, P < 0.05). In patients with more than 6 months of continuous BP treatment, the mean time to the first SRE was significantly longer than that in patients with less than 6 months of continuous BP treatment (7.2 vs. 3.4 months, P < 0.05). In addition, 12.2% of the physicians were not aware of the efcacy of BP in preventing and delaying SRE. Only half (52.3%) of the physicians agreed that the BP treatment should persist for at least 6 months unless it was intolerable. Conclusions: Our study suggested that prompt and persistent BP treatment was associated with a reduced risk of SREs. However, our survey also revealed that the proper application of BP was not as common as expected in China.     

Cholangiocarcinoma developed in a patient with IgG4-related disease

A 77-year-old man with jaundice and a pancreatic head tumor was referred to our hospital in August2006.The initial laboratory tests,computed tomography(CT)scan,magnetic resonance imaging(MRI),and endoscopic retrograde cholangiopancreatography suggested IgG4-related cholangitis and autoimmune pancreatitis.Oral prednisolone(PSL)was then administered.This treatment reduced the size of the pancreatic parenchyma,and the lower common bile duct(CBD)returned to its normal size.Thus,the oral PSL was gradually tapered to a maintenance dose.In February 2010,a CT scan and MRI showed segmental wall thickening and stenosis of the middle CBD,the progression of which led to extrahepatic obstructive jaundice.We suspected the emergence of a cholangiocarcinoma rather than the exacerbation of the IgG4-related sclerosing cholangitis because the stricture of the CBD was short and localized.Then,a percutaneous transhepatic biliary drainage was performed.The biopsy specimens obtained via the percutaneous transhepatic tract indicated an abnormal glandular formation,suggesting the presence of a moderate,well-differencated adenocarcinoma.The gross examination,microscopic examination and immunohistochemical analysis of the pancreaticoduodenectomy specimen suggested that a cholangiocarcinoma developed from the IgG4-related sclerosing cholangitis.     

合并症对老年晚期NSCLC患者治疗和生存期的影响

Objective:To identify the influence of comorbidity on the choice of treatment and survival of elderly patients (≥70 years) with advanced non-small cell lung cancer (NSCLC).Methods:The clinical characteristics and the choices of treatment of 177 elderly patients,who had a good performance status (PS＜1) were retrospectively analyzed in Oncology Department,Shanghai Pulmonary Hospital,between January 2005 to December 2005.Survival data were only analyzed in those whose had received chemotherapy.All patients were stratified by number of comorbidity as none (0),mild (1-2) and severe (≥3) groups.Results:The proportion of patients,who received chemotherapy,with none,mild and severe comorbidity was significantly different (79.3%,76.2% and 57.4%,P＝0.038),and there was also significantly different about palliative radiotherapy rate among the three groups (21 1%,11.7% and 37.0%,P＝0.014).The median survival and 1-year survival rate in none,mild and severe comorbidity groups,were 13.6 vs.10.2 vs.7.6 months and 53.5% vs.41.3% vs.20.8% respectively (Log-rank,P＝0.071).In univadate and multivariate Cox models analysis,only severe comorbidity was a independent hazard factor of survival of elderly patients with NSCLC.Relative ratio (RR,95% Cl):(2.09,1.06-4.15),P＝0.034.Conclusion:Comorbidity may affect the choice of treatment of elderly patients with advanced NSCLC slightly,but only severe comorbidity is a independent prognostic factor of survival.     

经内镜胆道金属支架引流术治疗恶性胆道梗阻的价值

目的回顾786例经内镜胆道金属支架引流术,探讨其治疗价值。方法在结合临床、影像学资料及尽可能获得的病理基础上确立恶性胆道梗阻,直接或在经内镜鼻胆管引流术（ENBD）、经内镜塑料内支架引流术（ERBD）过渡引流确定引流效果后行经内镜金属支架引流术（EMBE）,与姑息性手术及ERBD进行对照研究。结果一次操作成功率99.5%,减黄有效率为：满意68.4%,一般27.5%,无效4.1%;其中低位梗阻减黄有效率（满意＋一般）达96.6%,高位梗阻减黄有效率82.4%,支架平均通畅期289天,平均生存期310天,并发症率6.7%,死亡率1.2%。结论在严格掌握适应证的基础上,EMBE是安全有效解除恶性胆道梗阻的方法,对中晚期胆道肿瘤患者基本可替代姑息性胆道手术治疗。     

ERBD治疗恶性胆道梗阻20例临床观察

目的：探讨ERBD（内镜下逆行胆道内引流术）治疗难以手术切除的恶性胆道梗阻的效果。方法：通过十二指肠镜对20例由6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：18例患者血清总胆红素降至正常,余2例下降了约50％。结论：ERBD能明显减轻恶性胆道梗阻患者的黄疸症状,是一种有效的治疗方法。     

表阿霉素在恶性梗阻性黄疸治疗中的应用

目的 探讨表阿霉素治疗恶性梗阻性黄疸（MOJ）的安全性和可行性。方法39例MOJ患者接受胆道支架置放术或经皮穿肝胆道引流术（PTBD）后,血清胆红素未降至正常水平即接受动脉化疗栓塞术（TACE）。TACE方案：法玛新30mg／m^2和超液化碘油混合成乳剂。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Putgh分级观察肝脏损害。随访患者黄疸复发时间和生存期。结果39例MOJ患者TACE术前血清总胆红素浓度为52．1-91．4μmol／L,中位值72．7μmol／L。表阿霉素总量40-60mg,中位值55．0mg,超液化碘油2～25ml。白细胞计数下降：Ⅰ度41．0％,Ⅱ度35．9％,Ⅲ-Ⅳ度15．4％;恶心呕吐：Ⅲ～Ⅳ度100％。肝脏Child-Pugh分级：8例由A级升至B级,1例由A级升至C级,3例由B级升至C级。全部患者未出现心脏毒性。39例患者的生存期为2～72个月,中位值6．0个月。19例黄疸复发,复发率48．7％,黄疸复发时间2～20个月,中位值9．0个月。结论MOJ患者行有效引流后,即使胆红素未降至正常水平,用30mg／m^2表阿霉素和超液化碘油乳剂进行单纯化疗栓塞治疗原发病灶是安全和有效的。     

经内镜植入自膨式金属支架治疗结直肠癌性梗阻的安全性与有效性分析

目的探讨经内镜植入自膨式金属支架治疗结直肠癌性梗阻的安全性与有效性。方法选择收治的结直肠癌性梗阻患者48例,根据治疗方法的不同分为对照组22例与治疗组22例,对照组给予常规经内镜鼻胆管引流术治疗,治疗组给予经内镜植入自膨式金属支架治疗。结果所有患者都一次性完成手术,两组术后14天的总胆红素与直接胆红素含量都明显低于术前(P<0.05),同时术后14天治疗组的总胆红素与直接胆红素含量明显低于对照组(P<0.05)。治疗组术后14天内的急性胰腺炎、出血、胆漏、穿孔等并发症发生情况明显少于对照组(P<0.05)。所有患者术后随访6个月,治疗组随访3个月与6个月的生存率分别为100.0%和95.8%,对照组分别为83.3%和75.0%,治疗组随访3个月与6个月的生存率明显高于对照组(P<0.05)。结论经内镜植入自膨式金属支架治疗结直肠癌性梗阻的手术成功率高,能有效发挥减黄效果,减少术后并发症的发生,从而延长患者的生存时间。     

Percutaneous transhepatic hybrid biliary endoprostheses using both plastic and metallic stents for palliative treatment of malignant common bile duct obstruction

To evaluate clinical safety and efficacy of percutaneous transhepatic hybrid biliary prostheses for palliative treatment in patients with common bile duct obstruction caused by advanced malignancies. A total of 13 consecutive patients was treated with percutaneous transhepatic biliary endoprostheses concurrently using both plastic and metallic stents. Serum total bilirubin levels before and after stent placement were evaluated. The technical success rate, the period with no obstructive jaundice, patient survival and complications were also assessed. Median bilirubin levels decreased from 3.8 mg/dL before to 1.2 mg/dL after stent placement, and this difference was statistically significant. The median no‐jaundice period after bile duct stent placement was 6.0 months (range: 2–11 months), and overall survival time was 7.0 months. Of the 13 patients, nine did not have recurrent jaundice by the time of death, whereas four (31%) had recurrent jaundice. A second intervention was performed in these four patients. A new plastic stent was placed and jaundice did not recur up to the time of death. No serious complications such as cholangitis, pancreatitis or bile duct perforation developed. Percutaneous transhepatic hybrid biliary endoprostheses using both plastic and metallic stents can be useful as non‐invasive palliative treatment to relieve jaundice in patients with malignant obstructive jaundice.     

Application of endoscopic nasobiliary cutting in the treatment of hilar cholangiocarcinoma

Objective The aim of the study was to study the clinical efficacy and prognosis of endoscopically cutting the nasobiliary duct and leaving its residual segment as a biliary stent in the treatment of hilar cholangiocarcinoma (HC). Methods The clinical data of 55 patients with HC treated by endoscopic biliary drainage at the Gastrointestinal Endoscopy Center of our hospital (Renmin Hospital of Wuhan University, China) from August 2017 to August 2019 were retrospectively analyzed. According to different drainage schemes, patients were divided into the endoscopic nasobiliary cutting group (n = 26) and the endoscopic retrograde biliary drainage (ERBD) group (n = 29). The postoperative liver function indexes, incidence of postoperative complications, median patency period of stents, and median survival time of patients were compared between the two groups. Results Liver function indexes (total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase) were significantly decreased in 55 patients a week postoperaticely (P < 0.05), and decreases in liver function indexes in the endoscopic nasobiliary cutting group were more significant than those in the ERBD group (P < 0.05). The incidence of biliary tract infection in the endoscopic nasobiliary cutting group was significantly lower than that in the ERBD group (15.40％ vs. 41.4％, P < 0.05). In the endoscopic nasobiliary cutting subgroups, there were 1 and 3 cases of biliary tract infection in the gastric antrum cutting group (n = 21) and duodenal papilla cutting group (n = 5), respectively, and 0 cases and 2 cases of displacement, respectively; there was a statistically significant difference in terms of complications between the two subgroups (P < 0.05). The median patency period (190 days) and median survival time (230 days) in the nasobiliary duct cutting group were higher than those (169 days and 202 days) in the ERBD group, but there was no significant difference (P > 0.05). Conclusion The nasobiliary duct was cut by using endoscopic scissors in Stage Ⅱ after the bile was fully drained through the nasobiliary duct. The residual segment could still support the bile duct and drain bile. The reduction of jaundice and the recovery of liver enzymes were significant, and the incidence of biliary tract infection was low. Cutting off the nasobiliary duct at the duodenal papilla results in a higher incidence of biliary tract infection, and the residual segment of the nasobiliary duct is more likely to be displaced. Endoscopic nasobiliary-cutting drainage is an effective, simple, and safe method to reduce jaundice in the palliative treatment of HC.     

介入法支架植入术治疗恶性胆道梗阻

 目的探讨植入支架术治疗恶性胆道梗阻的疗效及其并发症。方法46例恶性胆道梗阻的患者在DSA的引导下接受经皮肝穿刺胆道支架植入术。结果46例放置了胆道支架，共用支架50只，其中13例为双支架，4例术后行经肝动脉化疗和（或）栓塞。减黄总有效率达85．4％。支架阻塞5例。主要并发症：败血症3例，肝功损害6例。结论支架植入术成功率高，减黄疗效好，是姑息性治疗恶性胆道梗阻安全简单的治疗方法。     

The use of ¹²⁵I seed strands for intraluminal brachytherapy of malignant obstructive jaundice

This study is sought to evaluate the feasibility and safety of using 12?I seed strands for intraluminal brachytherapy (ILBT) in the treatment of malignant obstructive jaundice (MOJ), and its clinical effect on stent patency. A total of 34 patients found to have MOJ were randomly assigned to an ILBT treatment group or a control group before biliary stent insertion. For the ILBT group, 12?I seed strands were implanted into the obstructive segment of the bile duct after stent insertion. For the control group, only the biliary stent was inserted. Alimentary and hematologic complications were examined for patients in the ILBT group. The stent patency of the two groups were compared. In the ILBT group, the number of 12?I seeds per strand varied from 6 to 16 (mean, 10.9), and were successfully implanted in 17 patients. Serum levels of bilirubin, alanine aminotransferase, granulocytes, and platelets assayed 2 and 4 weeks following the procedure demonstrated no significant difference between the ILBT group and the control group. The mean stent patency for ILBT group (10.2 months) was significantly longer than that of the control group (7.2 months, p=0.032). 12?I seed strands for ILBT is a feasible and safe palliative therapy for the treatment of MOJ, and may prolong stent patency.     

高位恶性胆道梗阻胆道双支架植入的疗效

目的 分析胆道双支架植入联合胆道外引流治疗高位恶性胆道梗阻（malignant high biliary obstruction,MHBO）临床疗效及应用价值。方法 MHBO患者96例,胆道双支架植入联合胆道外引流77例、胆道单支架植入并对侧引流11例、单纯胆道外引流8例;观察术后近、远期疗效。结果 胆道双支架植入联合胆道外引流77例,成功率为80.21%。96例MHBO患者术前总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶与术后第7、14天比较,差异有统计学意义（P<0.05）;术后第21天胆道双支架植入患者总胆红素下降率（92.56%）明显高于胆道单支架植入并对侧引流和单纯胆道外引流患者（61.53%）,差异有统计学意义（P<0.05）。77例胆道双支架植入患者3、6、9、12、15、18、21月生存率分别为98.70%、88.31%、76.62%、46.75%、18.18%、2.6%、1.3%。结论 胆道双支架植入联合胆道外引流治疗MHBO是一种安全有效的方法,不仅能够迅速退黄并恢复肝功能,为肿瘤的进一步治疗赢取了时间,而且能提高患者的生存质量及延长生存期。     

Neuroma of the common bile duct

Two cases of neuroma of the common bile duct (CBD) associated with jaundice and cholangitis both 15 years after cholecystectomy are presented. The surgical treatment, excision of the diseased CBD, followed by Roux-en-Y biliary drainage in one case and excision of the tumor with T-tube drainage in the other, was curative. A review of the world literature revealed 20 prior cases of CBD neuromas, 19 associated with jaundice. None was diagnosed prior to operation or autopsy. Mortality of treatment was 15% and all deaths were associated with a failure to excise the neuroma.