恶性梗阻性黄疸的介入治疗

目的：探讨介入治疗恶性梗阻性黄疸的临床价值。方法：31例恶性梗阻性黄疸患者先行PTCD（17例）及金属支架入术（14例）,1周后行肝动脉灌注化疗或栓塞治疗,结果：31例PTCD或胆道内支架置入后,血清总胆红素下降,2例患者2个月内死于与本治疗无关的原因,2例支架再狭窄,所有病例均获随访,平均生成9个月,最长26个月。结论：介入治疗恶性梗阻性黄疸是一种有效的方法;介入治疗可以延长恶性梗阻性黄疸患者的生存时间。     

介入疗法治疗恶性胆道梗阻性黄疸42例

目的探讨介入疗法对恶性胆道梗阻性黄疸的治疗效果。方法入组42例恶性胆道梗阻性黄疸患者,采用经皮肝穿刺胆管造影引流术(PTCD)和(或)裸金属内支架置入术,在胆道内置入内外引流管和(或)裸金属内支架,进行引流胆汁的姑息性治疗。结果全组42例患者经皮肝穿刺胆管术均一次成功,成功率100%。术后2周,血清总胆红素水平明显下降,肝功能明显改善。本组患者平均生存期为9个月,最长可达20个月。结论介入疗法对恶性胆道梗阻性黄疸是一种有效的姑息性治疗手段。     

58例恶性梗阻性黄疸的治疗分析

目的:对58例恶性梗阻性黄疸的治疗进行分析.方法:回顾性分析恶性梗阻性黄疸患者58例,男性30例,女性28例,平均年龄(60±29)岁,所有患者均经CT及MRI检查,结合临床确诊为恶性梗阻性黄疸,全部行PTCD或胆道支架置入,28例患者术后给予TACE治疗,3例患者行PTGD治疗.结果:58例患者均胆道穿刺成功,置入引流管或放置胆道支架,各项胆红素(TBL,DBL,IBL)下降至正常者50例,无明显下降者5例,升高者3例,28例行TACE治疗,6例行PTGD治疗.结论:PTCD及阴道支架置入缓解梗阻性黄疸明显,先TACE治疗患者生存期超过未行TACE治疗患者,高位梗阻患者(特别是老年患者)预后较差.     

恶性胆道梗阻双介入治疗13例

目的：评价胆道引充及结合动脉内灌注化疗在恶性胆道梗阻中的治疗效果。方法：在13例患者中（男8例,女5例）4例行经皮肝穿胆道引流（PTCD）,9例放置胆道内支架,置入支架类型：国产镍钛记忆合金支架6例,被膜支架3例,所有病例定期做肿瘤供动脉插管灌注化疗。结果：W一部病例经引流后梗阻性黄疸症状迅速消失,黄疸逐日消退,随访4例13个月,7例于PTCD和支架放置术后4至11个月死亡,生存的6例无再闭塞发生,支架无移位。结论：本疗法是一种对恶性梗阻性黄疸比较理想的姑息性治疗方法。     

恶性梗阻性黄疸患者的双介入治疗

目的 :探讨恶性梗阻性黄疸患者介入治疗的近期疗效。方法 :采用金属支架植入并与动脉灌注或栓塞化疗相结合的双介入治疗方法。结果 :12例均成功植入胆道支架 ,行动脉灌注化疗 49次 ,栓塞化疗 13次。肿瘤缩小 1/ 2者 2例 ,1/ 3者 3例。胆红素下降接近正常者 6例。平均存活 9 3个月。结论 :金属内支架植入并结合肝动脉超选药物灌注或栓塞治疗梗阻性黄疸减黄可靠 ,能明显提高生活质量 ,延长患者的生存期。     

胃癌术后复发致梗阻性黄疸的挽救治疗

目的:总结胃癌术后复发引起的梗阻性黄疸的治疗。方法:回顾性分析2001-2010年我院收治的48例因胃癌术后复发所致梗阻性黄疸的资料。男性31例,女性17例。根治性切除术后42例,姑息性切除术后6例。黄疸发生于术后6个月以内、6-12个月(包括12个月)、13-24个月(包括24个月)、25个月及以上者分别为5例、14例、17例、12例。外科手术治疗12例,其中胆管空肠吻合4例,T管引流8例;经内镜放置胆道内支架7例;PTCD 17例;药物减黄治疗12例。34例经减黄治疗后行放、化疗综合治疗。结果:12例手术治疗者,2周内黄疸完全消退。7例经内镜置入内支架者,4周内黄疸完全消退率为85.7%。17例成功行PTCD患者4周内黄疸完全消退率为58.8%。12例黄疸较轻者药物治疗9例有效。全组患者中位生存期为7.5月,1年生存率为39.9%。结论:胃癌术后复发引起的梗阻性黄疸者愈后不佳;极积有效的减黄治疗可改善患者的生活质量,微创减黄可作为首选方法;对一般状态较好者,减黄后进行放、化疗综合治疗,有可能延长患者的生存期。     

胆道双支架联合高强度超声聚焦刀治疗恶性梗阻性黄疸的临床观察

目的探讨高强度超声聚焦刀(HIFU)联合胆道双支架治疗恶性肝门部胆管梗阻性黄疸的安全性与疗效。方法对32例恶性肝门部胆管梗阻性黄疸患者植入64枚胆道支架,其中17例(试验组)术后5~7 d后行HIFU治疗;15例(对照组)术后未行任何抗肿瘤治疗。结果支架置入1个月后2组患者黄疸均得到有效缓解,2组患者黄疸缓解率比较,差异无统计学意义(P>0.05)。试验组梗阻性黄疸再次出现的时间为术后4~13个月,中位时间为7.5个月;对照组梗阻性黄疸再次出现的时间为术后2~6个月,中位时间为4.1个月,2组比较,差异有统计学意义(P<0.001),2组不良反应均可耐受。结论 HIFU联合胆道双支架治疗恶性肝门部胆管梗阻性黄疸是安全有效的方法。     

经皮肝内支架近距离照射治疗梗阻性黄疸

对28例梗阻性黄疸进行了介入治疗，认为行经皮经肝胆汁引流术（PTCD)、内支架置人术，加近距离照射是治疗恶性梗阻性黄疸的有效方法，明显改善患者生活质量，延长存活时间。     

恶性高位梗阻性黄疸的介入治疗

背景与目的:侵犯或压迫肝门部胆管的恶性肿瘤造成的胆道高位梗阻,因梗阻部位多位于胆总管上段、肝总管,左右叶肝管甚至互不相通,单侧PTBD引流只能局限于引流管头端所放置的单一分支肝管,部分病例PTBD术后黄疸没有明显减退,甚至短期内加重,导致病情进一步恶化。本研究探讨左右叶双侧PTBD结合内支架术治疗恶性高位梗阻性黄疸的疗效。方法:17例高位恶性梗阻性黄疸的患者(男性11例,女性6例,平均年龄63.4岁),行左、右叶双侧PTBD结合内支架治疗。置入2枚支架的15例;2例为一侧肝管至胆总管置入支架,另一侧留置引流管。15例PTBD术后行TAI/TACE或放疗。结果:全部患者PTBD手术成功。治疗后总胆红素明显下降,由(357.7±142.5)μmol/L降至(174.7±87.6)μmol/L。引流通畅中位时间8.9个月,全组生存中位时间11.2个月。结论:左右叶双侧PTBD结合内支架治疗高位恶性梗阻性黄疸近期疗效肯定,早期引流与多支引流同样重要。     

金属内支架置入治疗恶性梗阻性黄疸12例

目的 研究经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸的临床效果并进行分析。方法 12例恶性梗阻性黄疸患者共植入14枚胆道内支架,其中原发性肝癌4例,胃癌肝门转移2例,胰腺癌3例,壶腹癌3例,10例支架植入后进行了局部治疗。结果 12例采用经皮肝穿放置胆道支架均获得成功,技术成功率8.3％（1／12）,早期并发症率16.7％（2/12）,6个月生存率58.3％,6个月胆道再狭窄率25％（3／12）,春中1例进行了再次介入治疗。结论 经皮胆道内支架置入术是姑息性治疗手术不能切除的恶性梗阴性黄疸患者的有效方法。     

金属胆道支架植入联合介入化疗治疗恶性梗阻性黄疸的疗效

目的评价金属胆道支架植入联合介入化疗治疗恶性梗阻性黄疸的疗效。方法对20例接受金属胆道支架植入联合介入化疗治疗的恶性梗阻性黄疸患者,回顾性分析血清总胆红素和谷丙转氨酶的变化,以及联合介入化疗后的生存时间和生存率。结果术后两周,血清总胆红素和谷丙转氨酶较术前明显下降,术后四周,9例患者的血清总胆红素和谷丙转氨酶恢复正常。本组病例的中位生存时间为6个月,半年及一年生存率分别为60%及35%。结论对于无法外科手术治疗的恶性梗阻性黄疸患者,金属胆道支架植入联合介入化疗能明显提高其生活质量及生存率。     

58例恶性梗阻性黄疸的治疗分析

目的：对58例恶性梗阻性黄疸的治疗进行分析。方法：回顾性分析恶性梗阻性黄疸患者58例,男性30例,女性28例,平均年龄（60±29）岁,所有患者均经CT及MRI检查,结合临床确诊为恶性梗阻性黄疸,全部行PTCD或胆道支架置入,28例患者术后给予TACE治疗,3例患者行PTGD治疗。结果：58例患者均胆道穿刺成功,置入引流管或放置胆道支架,各项胆红素（TBL,DBL,IBL）下降至正常者50例,无明显下降者5例,升高者3例,28例行TACE治疗,6例行PTGD治疗。结论：PTCD及胆道支架置入缓解梗阻性黄疸明显,先TACE治疗患者生存期超过未行TACE治疗患者,高位梗阻患者（特别是老年患者）预后较差。     

恶性梗阻性黄疸姑息手术术式选择探讨

 目的　探讨对恶性梗阻性黄疸姑息手术术式的选择。方法　对112例姑息性手术治疗的恶性梗阻性黄疸患者临床资料进行回顾性分析。结果　手术死亡率7.1 %（8／112）;术后复发性胆管炎发生率17.3 %（13／75）;术后生存期：胆肠Roux-en-Y吻合术组［（9.4±1.6）个月］与开腹支架内引流术组［（9.8±12.5）个月］、经皮经肝胆和引流（PTCD）内支架引流术组[（9.0±3.1）个月]差异无统计学意义（均P＞0.05）,与开腹桥式内引流术组［（6.8±1.7）个月］差异有统计学意义（P＜0.05）,与逆行胰胆管造影（ERCP）内支架引流术组［（3.5±2.2）个月］和单纯开腹探查术组［（2.8±2.7）个月］比较差异有统计学意义（P＜0.01）。结论　胆肠Roux-en-Y吻合术式适用于胆管中、下段梗阻,开腹内支架引流术式适用于肝门胆管梗阻患者,ERCP内支架术式仅适用于胆管下段的梗阻,PTCD内支架术式适用于任何一段的梗阻。胆管空肠Roux-en-Y吻合术、开腹支架内引流术和PTCD内支架引流术能够延长患者术后生存期和提高生活质量。     

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.     

经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸临床观察

目的研究经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸的临床价值。方法28例恶性梗阻性黄疸接受经皮经肝胆道内支架置入术,男18例,女10例。胆管癌13例,胰头癌4例,胆囊癌3例,肝门区转移癌8例。共置入胆道内28枚金属内支架。结果28例采用经皮经肝穿刺置入胆道内支架均获得成功。结论经皮胆道内支架置入术是姑息治疗手术不能切除的恶性梗阻性黄疸的有效方法,配合动脉内灌注化疗可提高恶性阻塞患者的生存率。     

Concomitant chemoradiation treatment in the management of patients with extrahepatic biliary tract recurrence of gastric carcinoma

BACKGROUND: The aim of this study was to determine the role of concomitant chemoradiation in the alleviation of obstructive jaundice in patients with extrahepatic biliary tract metastases from gastric carcinoma. METHODS: Thirteen patients with good performance status who had obstructive jaundice resulting from extrahepatic biliary metastases after gastrectomy for gastric carcinoma were treated with palliative intent. Treatment consisted of insertion of a percutaneous transhepatic choledochal drainage (PTCD) catheter followed by external radiation up to a total dose of 40-60 grays in combination with chemotherapy (cisplatin 20 mg/m(2)/day, 5-fluorouracil 600 mg/m(2)/day, and leucovorin 90 mg/m(2)/day for 96 hours during the first and fifth weeks) on an outpatient basis. RESULTS: The concomitant chemoradiation produced a good palliative effect in all 13 patients. Hyperbilirubinemia continued to improve after treatment, patients' clay-colored stool resolved within an average of 4 weeks (range, 2-6 weeks), and bilirubin levels returned to normal. The PTCD catheter could be removed after treatment was completed (the seventh week); the mean duration of PTCD placement was 2 months. The entire treatment course was performed on an outpatient basis; hospital admission was necessary only for PTCD insertion and chemotherapy. Ten patients died of their disease, with an average survival of 14.4 months (range, 4-31 months) from the time of PTCD insertion. Three patients are still alive at 16, 21, and 8 months. Biliary tract patency was maintained until death. No serious treatment-related complications occurred, and no endoprothesis or intraluminal brachytherapy was needed in this study. CONCLUSIONS: Satisfactory palliation can be achieved by concomitant chemoradiation for patients with obstructive jaundice resulting from extrahepatic biliary metastases from gastric carcinoma, providing an alternative treatment choice for these patients.     

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。     

肝门部胆管癌内支架置入术后再梗阻的介入处理

 目的　探讨肝门部胆管癌内支架置入术后再梗阻的原因及其有效的治疗方法。方法　 13例内支架置入术后病人出现再梗阻症状 ,8例行CT检查 ,5例MR检查后 ,再行经皮肝穿刺胆道引流(PTCD) ,5例再次行金属内支架置入术 ,共使用 5枚金属内支架 ,6例配合动脉灌注化疗 ,使用药物有 5 FU、健择 ,每隔 3～ 5周重复 1次。结果　病人再梗阻可能的原因是肿瘤向支架近端生长 (5例 ) ,支架腔内堵塞 (9例 ) ,左侧胆管梗阻 (1例 )和胆道感染化脓 (8例 )。 13例行PTCD均获得成功。 1例病人由于肿瘤发展侵犯多支肝内胆管和严重的胆道感染于PTCD术后 15天死亡 ,5例于引流 5～ 10天后再次行金属内支架置入术 ,共使用 5枚 ,其中右侧胆道 4枚 ,左侧胆道 1枚 ,7例带管出院 ,6例于肝功能明显改善后先后行腹腔动脉灌注化疗 1～ 4次。经 30个月的随访 ,13例病人自初次PTCD术后半年、1年和 2年的生存率分别是 10 0 % ,75 %和 33.3% ,其中 1例病人带管引流 2年尚在生存 ,发生了穿刺道皮肤转移。结论　肝门部胆管癌内支架置入术后再梗阻的原因多种 ,再次PTCD引...     

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。     

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.