经皮胆道支架联合支架内外粒子植入治疗胰头癌伴胆道梗阻

目的 探讨胰头癌伴梗阻性黄疸者在施行经皮胆道支架成形术的基础上,经胆道支架内外置入放射性粒子治疗胰头癌的疗效.方法 23例胰头癌伴梗阻性黄疸患者均行PTCD基础上先行胆道支架成形术,然后经支架留置8F胆道引流管,最后将装有粒子条的导管经胆道引流管送入所需照射部位,随后配合CT引导下经皮穿刺胰头癌放射性粒子植入术治疗.结果 23例胰头癌伴梗阻性黄疸者,22例成功施行经皮胆道支架成形术,中位支架通畅期为12个月,中位生存期为11.2个月.所有患者均顺利施行支架内外放射性粒子植入术,未出现明显不良反应.术后所有患者的胆红素均降至正常或接近正常(P＜0.05).结论 经皮胆道支架成形术后联合支架内外放射性粒子植入术治疗胰头癌伴梗阻性黄疸是一种安全有效的方法,值得临床进一步推广.     

胆道支架与十二指肠支架联合应用治疗胆道消化道梗阻

目的评价联合应用双支架治疗胆道及十二指肠梗阻的疗效。方法20例患者实施治疗。16例患者先经过经皮肝穿刺置入胆道支架解决胆道梗阻,患者出现十二指肠梗阻的症状后,14例患者经口腔、2例患者经胃造瘘口置入十二指肠支架。有4例患者同时有胆道和十二指肠梗阻的症状,同时置入胆道和十二指肠支架。结果所有患者都成功置入了双支架,没有出现并发症和再梗阻的表现。生存期1~14个月,平均5个月。结论联合双支架置入是治疗胆道和十二指肠梗阻的有效的方法。     

胆道支架置入联合碘油化疗药治疗胰头癌合并阻塞性黄疸的临床应用

目的探讨经皮肝穿胆道支架置入联合经皮穿刺瘤内注入碘油化疗药乳剂(chemotherapic agents lipiodol emulsion,CALE)术治疗胰头癌合并梗阻性黄疸的近期疗效和安全性。方法 24例已经明确诊断的胰头癌合并梗阻性黄疸患者,所有患者先在B超联合DSA下行经皮肝穿胆道支架置入术,3~7天后在CT下行经皮穿刺胰头癌瘤内CALE注入术。统计患者临床症状改善情况、肿瘤内CALE存积情况及术后并发症等。结果 1个月后24例患者黄疸均现减退,血清胆红素较术前明显下降(P0.01);3例肿瘤内CALE存积均匀,17例部分缺损,4例病变明显扩展;临床表现明显疼痛的21例患者中10例患者疼痛完全缓解,8例患者疼痛明显减轻,3例无效,疼痛缓解有效率为85.7%。2个月后24例患者血清胆红素继续下降。6个月随访过程中未出现与手术相关重症胰腺炎、胰漏及肠道出血等严重并发症。结论经皮肝穿胆道支架置入联合瘤内注药术治疗晚期胰头癌合并梗阻性黄疸患者安全、有效,能够短时间内缓解疼痛及黄疸等症状,控制肿瘤生长,明显改善患者生活质量。     

胃流出道恶性梗阻的金属支架置入治疗

目的探讨金属支架治疗胃流出道恶性梗阻的操作技术及其临床疗效。方法12例胃流出道恶性梗阻患者中,胃恶性淋巴瘤1例,胰体癌术后浸润胃肠吻合口1例,胃窦癌6例,胰头癌4例。在X线电视监视下经口置入国产镍钛合金网状裸支架。除4例体质虚弱外,余8例均接受动脉插管化疗或全身化疗。结果12例患者共放置金属支架14枚,其中,2例放置2枚支架。10例放置1次成功,2例放置2次成功。所有病例梗阻症状均明显缓解,并逐渐能进半固体软食,生活质量明显提高。随访2～18个月,2例出现支架梗阻后再次置入支架,1例胆道梗阻行胆道外引流术。未发生出血、穿孔、支架移位等严重并发症。结论金属支架是胃流出道恶性梗阻安全有效的治疗方法,可迅速缓解症状,改善患者体质,提高患者的生活质量,结合化疗有望延长患者的生存期。     

胆道内支架引流术结合立体定向放射治疗恶性梗阻性黄疸

目的　评价经皮肝穿刺胆道内支架置入术配合立体定向适形放射治疗对恶性梗阻性黄疸的疗效。方法　 15例恶性梗阻性黄疸采用经皮肝穿刺法置入 19个金属内支架。支架置入后随即开始立体定向适形放射治疗。结果　 15例胆道支架植入术全部成功。随访 12个月以上。 3例分别在术后 3、4、11个月无黄疸死亡 ,其余均存活超过 1年。 1年生存率 80 %。结论　胆管癌在经皮肝穿刺胆道内支架置入术有效减黄之后 ,针对肿瘤实施先进的立体定向适形放射治疗能明显延长恶性梗阻性黄疸病人的生存期     

金属内支架置入术治疗胃十二指肠恶性梗阻

目的　探讨不能手术的胃十二指肠恶性梗阻金属内支架治疗方法和效果。方法　 67例胃十二指肠恶性梗阻 ,胃窦及幽门部梗阻 2 7例 ,十二指肠降段及以远梗阻 2 6例 ,胃十二指肠及胃空肠吻合口梗阻 14例 ,均在X线透视下采用介入放射学方法 ,经口腔共置入记忆合金网状内支架 84枚 ,其中 17例因支架置入 6个月后再梗阻又放置了第 2枚支架。结果　 67例患者支架置入成功后 ,梗阻症状迅速解除 ,当日即能进食。术后 1个月与术前比较 ,体重平均增加 4.7kg ,无严重并发症发生。随访 1～ 2 0个月均进食情况良好。结论　金属内支架置入术操作简单、微创、可重复 ,是无法手术治疗的胃十二指肠恶性梗阻首选有效的治疗方法。     

金属内支架在治疗恶性胆道梗阻中的应用

目的 :探讨经皮肝穿刺胆道金属内支架置入治疗恶性胆道梗阻临床应用价值。方法 :对 2 7例恶性梗阻性黄疸患者行经皮肝穿胆道金属内支架置入术。男 18例 ,女 9例 ,其中肝癌 6例 ,胆管癌 7例 ,胰腺癌 5例 ,转移癌 9例。梗阻部位在胆总管 12例 ,肝总管肝门区 15例。结果 :经皮肝胆道内支架置入术技术成功率为 10 0 %。 2 7例共置入金属内支架31枚 ,术后 1周复查肝功能血清学指标 ,总胆红素、碱性磷酸酶和谷丙转氨酶较术前明显下降 ,P <0 .0 0 1。随访开通时间平均为 14 1天 ,半年开通率 5 5 .6 % ,并发症发生率为 2 5 .9% ,主要为胆道感染 ,胆道出血等。结论 :金属内支架置入术是治疗胆道梗阻性黄疽的安全、有效的姑息治疗手段     

术前减黄对70岁以上高龄低位胆道恶性梗阻性黄疸患者胰十二指肠切除术疗效的影响

目的探讨术前减黄对70岁以上低位胆道恶性梗阻患者胰十二指肠切除术疗效的影响。方法回顾总结了6例70岁以上的低位胆道恶性梗阻患者术前减黄情况（包括减黄成功和失败）及术后恢复、生存情况。结果此6例患者中：1例术前减黄失败,1例术前减黄仅1 d,此2例患者术后早期死于肝功能衰竭导致的多器官功能衰竭;其余4例术前成功减黄,减黄时间均为10 d以上,血清胆红素和转氨酶水平明显下降,肝功能显著改善,手术均获得成功,术后恢复比较顺利,术后定期化疗,最终获得了较为满意的生存期,其中2例至今仍然健康存活。结论对于一些黄疸较重、肝功能受损严重的高龄低位恶性胆道梗阻患者,有必要先行微创胆道引流以减轻黄疸,等到肝功能明显改善后再施行胰十二指肠切除术,这样可以提高手术成功率,改善患者生活质量,显著延长患者生命。     

经皮国产胆道金属内支架置入术治疗恶性梗阻性黄疸

目的:探讨国产胆道金属内支架的经皮经肝穿刺置入技术及其临床应用价值.方法:1996年7月～2006年10月经皮经肝穿刺胆道金属内支架置入术治疗恶性梗阻性黄疸患者167例.其中67例患者置人国产胆道金属内支架,男42例.女25例,年龄28～88岁.首先经皮经肝穿刺胆道造影,再选择性穿刺理想肝内胆管分支,送入导丝导管通过胆道梗阻段后导入硬交换导丝,沿该导丝送入球囊预扩张病变节段后置入胆道金属内支架,最后送入内-外引流管引流观察5天左右后撤出.结果:67例患者置入国产胆道金属内支架96枚,术中均未出现严重并发症,术后住院治疗5～10天.术后1个月复查血清总胆红素,均降至术前的1/2以下,44例降至正常范围.谷丙转氨酶、谷氨酸转肽酶均较术前显著下降.6个月生存48例,12个月生存14例,2例生存2年.结论:国产胆道金属内支架置入术治疗恶性梗阻性黄疸安全有效,价格低,治疗效果与进口胆道支架无明显差异.可明显缓解黄疸,减轻痛苦,提高生存质量,改善肝脏功能,延长生存时间.     

胆道及胰腺肿瘤多种介入方法联合应用的治疗效果分析

目的:探讨胆道及胰腺肿瘤多种介入方法联合应用的治疗效果。方法:23例中胰头癌8例、肝门部胆管癌4例、中下段胆总管癌5例、胰头部转移癌4例、胆囊癌和壶腹癌各1例,分别采用经皮肝穿刺胆管引流术(PTCD)内外引流6例及单纯外引流4例、胆道支架植入8例、十二指肠支架植入5例,全部给予多靶点动脉内药物灌注或/和栓塞治疗共52次。结果:术后1周实验室检查,血胆红素、碱性磷酸酶及谷丙转氨酶均明显下降。随访3年1例、12个月10例、6个月9例、3个月2例仅1例2个月随访时已死亡。结论:PTCD、胆道支架植入及十二指肠支架植入术联合动脉内药物灌注或/和栓塞治疗应用于胆道及胰腺肿瘤,可明显缓解黄疸症状,提高生存质量,有效延长生存时间,是一种安全、有效的姑息治疗方法。     

经皮穿肝经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻

目的:探讨胆管和十二指肠恶性梗阻双途径联合支架置入介入治疗的方法和效果.方法:23 例胆管和十二指肠恶性梗阻,17例先经皮肝穿刺置入金属支架解除胆管梗阻,出现十二指肠梗阻后,再在X线透视下,经口腔置入记忆合金网状十二指肠内支架.6例因胆管与十二指肠恶性梗阻并存,先置入十二指肠内支架并同时置入胆管支架.测定术前、术后血清总胆红素水平及体重并进行t检验.结果:23例患者双途径联合支架置入成功后,术前、术后血清总胆红素水平及体重比较差异均有显著性意义(P＜0.05).十二指肠支架置入后,消化道梗阻症状迅即解除,当日即能进食,均无严重并发症发生.随访1～20个月进食情况均良好.结论:经皮肝穿经口腔双途径联合支架置入治疗胆管和十二指肠恶性梗阻是首选的有效治疗方法.     

Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

Purpose The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42–80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting.     

恶性胆道梗阻ERCP表现及胆道内支架治疗

目的:评价ERCP在恶性胆道梗阻诊断及胆道内支架治疗的价值。方法:回顾性分析19例恶性胆道梗阻ERCP表现和内支架植入情况。结果:19例恶性胆道梗阻ERCP表现直接征象:胆管截断征9例、不规则偏心性或向心性狭窄9例、不规则充盈缺损1例。间接征象:梗阻近端胆总管中、重度扩张,肝内胆管扩张,呈软藤征;胆囊增大;胰管扩张等。19例共植入支架22个,一次操作成功率95.65%,低位梗阻减黄有效率达92.85%,高位梗阻减黄有效率达80.00%。结论:ERCP对于胆道梗阻定位、定性诊断有很大价值,胆道内支架引流术可以作为恶性胆道梗阻姑息性治疗的首选方法。     

晚期胰腺癌合并梗阻的三介入治疗

目的 :探讨晚期胰腺癌合并阻塞性黄疸及十二指肠梗阻的介入治疗方法 ,对供血动脉药物灌注及胆道支架、十二指肠支架植入的临床效果予以讨论。方法 :采用seldinger技术经股动脉插管胰腺供血动脉灌注化疗药物 ,经皮经肝穿刺植入胆道支架 ,经口经胃植入十二指肠支架。结果 :6例病人疼痛症状明显缓解 ,黄疸及十二指肠梗阻解除。结论 :动脉灌注化疗药物对降低肿瘤生长速度和减轻疼痛是一种可选择的有效方法 ,但对减小肿瘤体积、改善黄疸及十二指肠梗阻疗效轻微 ,经皮经肝植入胆道支架、经口经胃植入十二指肠支架可有效解除黄疸及十二指肠梗阻 ,改善症状、延长病人生存期。     

A novel combination of percutaneous stenting with iodine-125 seed implantation and chemotherapy for the treatment of pancreatic head cancer with obstructive jaundice

PurposeInsertion of radioactive strips through the biliary stent has been reported to offer longer survival and patency than an uncovered conventional self-expanding metal stent in patients with unresectable malignant biliary obstruction. The aim of this study was to investigate the safety and effectiveness of intraluminal brachytherapy combined with ¹²⁵I seed implantation and transarterial infusion chemotherapy for the treatment of pancreatic head cancer with obstructive jaundice.MethodFrom October 2012 to January 2018, 21 consecutive patients diagnosed with biliary obstruction caused by locally advanced, nonmetastatic pancreatic cancer with cytologically or histologically confirmed by biopsy were enrolled and receive treatment with intraluminal brachytherapy using ¹²⁵I seed strand and CT-guided percutaneous radioactive seed implantation therapy. The procedure-related and radiation complications were assessed. The outcomes were measured in terms of stent patency, patient survival, complications related to the procedure.ResultOne of the 22 patients (4.5%, 1/22) with pancreatic head cancer failed to perform the above procedure because the guidewire was unable to pass through the obstruction segment. The remaining 21 patients (95.5%, 21/22) with pancreatic head cancer with obstructive jaundice were successfully placed with biliary stents and radioactive strips through drainage tubes. The median number of ¹²⁵I seeds loaded was 15, ranging from 12 to 17. After the chemotherapy with gemcitabine and cisplatin, no adverse reaction of Grade Ⅲ ～ Ⅳ occurred in all cases. Median stent patency was 12.50 months (95% CI: 10.26, 14.74). By May 2019, all 21 patients had died, with overall survival of 5.2–23.3 months, with a median survival of 13.20 months (95% CI: 10.96, 15.44).ConclusionPercutaneous ¹²⁵I seed implantation combined with insertion of radioactive strips through the biliary stent has the characteristics of less trauma, fewer complications, simple operation, and so on. These procedures bring remission of obstructive jaundice combined with the increased survival for the treatment of obstructive jaundice caused by unresectable pancreatic head cancer if follow-up chemotherapy is carried out. The long-term efficacy of this treatment combination needs to be confirmed by further multicenter, large sample size prospective randomized controlled studies.     

Expandable metallic biliary endoprostheses: preliminary clinical evaluation

A biliary endoprosthesis constructed of self-expanding metallic "Z" stents was placed in 23 patients with obstructive jaundice. The biliary obstruction was due to a malignant neoplasm in 21 patients and a postoperative biliary stricture in two patients. The lesions affected the intrahepatic biliary ducts in 13 patients. Twelve patients had undergone radiation therapy before stent placement. The endoprostheses consisted of 196 expandable metallic biliary stents placed singly (n = 10) or in tandem (n = 186). As many as 18 stents were used to relieve an obstruction in one patient. A transhepatic approach was employed in all patients except one in whom stents were placed through a T-tube tract. Within 1 week after placement, all stents expanded to at least 90% of their original diameter. Three misplaced, two deformed, and two dislodged stents caused no obvious clinical problems. At follow-up, which ranged from 2 to 59 weeks, five patients experienced recurrent jaundice. Two patients with recurrent jaundice due to obstruction of the bile duct containing the stent were treated with external catheter drainage. The expandable biliary endoprosthesis is suggested as an effective treatment for benign and malignant biliary obstruction.     

Efficacy of biliary endoprostheses using expandable metallic stents in obstructive jaundice--long-term results of three different types of stent]

Three types of expandable metallic stents were used to relieve obstructive jaundice in 59 patients. They consisted of 3 cases with benign stricture, and 56 with malignant obstruction including 28 of cholangiocarcinoma, 17 of pancreatic carcinoma, 9 of lymph node metastases, and 2 of gall bladder carcinoma. The median age of patients was 68.9 years. Of 56 cases with malignant obstruction, 51 cases were able to remove external drainage catheter. In these 51 cases, 35 patients died, and 16 are still alive. No significant difference was noted in the incidence of stent destruction or migration in three types of stents. The average survival period was 189.9 days in 35 patients who died after withdrawal of external drainage. Twenty-three of 35 patients had no recurrence of obstructive jaundice. Sixteen patients with malignant obstruction are still alive and have been observed for 22 to 764 days. The 30 day mortality rate was 6.8%. Three cases of acute cholecystitis were noted after procedure. It is warranted to say that endoprostheses using expandable metallic stents will be the major treatment of choice for biliary obstruction because of long term patency and low complication rate.     

Small bowel perforation after duodenal stent migration: An interesting case of a rare complication

Duodenal stents are frequently used for palliating malignant gastric outlet obstruction.Successful stent placement relieves obstructive symptoms,is cost effective,and has a relatively low complication rate.However,enteral stents have the potential of migrating distally and rarely,even lead to bowel perforation.We present a rare case of a duodenal stent placed as a palliative measure for gastric outlet obstruction due to unresectable pancreatic cancer that migrated distally after a gastrojejunostomy resulting in small bowel perforation.     

金属与塑料支架姑息性治疗恶性胆道梗阻疗效对比研究

目的 :比较经皮肝穿金属支架与塑料支架置入术姑息性治疗恶性梗阻性黄疸的临床疗效及开通时间 ,探讨两种支架治疗的适应证。方法 :对 45例金属支架与 3 4例塑料支架介入治疗恶性梗阻性黄疸的临床资料进行回顾性分析。结果 :两组术后对降低胆红素和改善临床症状均有明显疗效 ,选择病例以肝门部梗阻占多数。术后早期并发症较少 ,晚期并发症主要为支架阻塞。金属支架中位开通时间为 2 76d ,明显长于塑料支架的 112d(P <0 .0 1)。结论 :两种支架均能有效解除胆道梗阻 ,且对高位梗阻具有优势 ,适用于不宜手术者。金属支架开通期明显长于塑料支架 ,但价格较贵 ;估计生存期 >3个月者 ,宜选择金属支架 ;生存期 <3个月和 /或经济条件不许可者 ,可选用塑料支架