经皮肝穿胆道支架置入治疗恶性胆道梗阻的临床研究

目的:总结经皮肝穿刺胆道金属内支架植入治疗恶性胆道梗阻的临床疗效及经验.方法: 92例恶性胆道梗阻性黄疸患者,采用经皮肝穿刺肝胆管支架置入术.根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式.结果: 92 例患者中,91例胆道支架成功放置,其中12例放置双支架,支架扩张良好,引流通畅,血清胆红素下降明显.术后死亡2例,胆道出血3例,腹水渗漏6例,胆漏2例,支架移位1例,胆管炎9例,胆道再阻塞11例.结论对不能手术的恶性胆道梗阻性黄疸患者,经皮肝穿刺胆道内支架植入术创伤小,可提高患者的生存质量,延长生存期,是一种较为安全、有效的方法.     

经皮肝穿刺内支架植入治疗恶性胆道梗阻52例报告

目的总结经皮肝穿刺胆道金属内支架植入治疗恶性胆道梗阻性黄疸的临床疗效及其经验。方法在DSA下对52例恶性胆道梗阻性黄疸患者,经皮肝穿刺胆道内置入金属内支架治疗。根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式。结果52例患者中,45例植入单支支架于肝总管和(或)胆总管,7例植入2支以上支架于总管和分支胆管,其中2例为肝内胆管支架再狭窄后的重新植入。52例患者术前血清胆红素(236.25±112.27)μmol/L,术后2周复查血清胆红素下降到(120.40±51.20)μmol/L(P<0.01),并发症5例(9.62%)。结论经皮肝穿刺胆道内支架植入术是治疗恶性胆道梗阻性黄疸的有效的治疗方法。     

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。     

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。     

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。     

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。     

经皮胆道支架置入在恶性梗阻性黄疸的应用

[目的]探讨经皮肝穿刺胆道支架置入术在恶性胆道梗阻的临床应用价值。[方法]对37例恶性梗阻性黄疸患者实施经皮肝穿刺胆道支架置入术，其中15例合并选择性动脉灌注化疗术。[结果]经皮肝穿刺胆道支架置入术技术成功率100％。37例共置入支架41枚，其中30例置入单支架，4例置入双支架，3例右侧置入支架，左侧保留外引流管。术后2周，35例黄疸消退显著．血清总胆红素（STB）由术前（312．5±74．3）μmol／L下降至（96．53±47．3）μmol／L，碱性磷酸酶（AKP）由术前（692．5±160．5）IU／L下降至（196．55±105．2）IU／L，与术前相比均有显著性差异（P〈0．01）。33例获得随访，生存期5．5—21个月．平均9．5个月。[结论]经皮肝穿刺胆道支架置入术治疗恶性梗阻性黄疸创伤小、减黄效果确切，有利于后续抗肿瘤治疗，对于延长患者生命，提高生活质量具有切实疗效。     

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。     

胆道支架放置术治疗恶性胆道梗阻的临床应用

目的：探讨胆道支架放置术治疗恶性胆道梗阻性黄疸的疗效和安全性。方法：恶性梗阻性黄疸病人24例，均采用胆道支架放置术的治疗方法，分别观察血清胆红素下降程度，手术并发症，并随访病人生存期和胆道支架维持通畅时间。结果：所有病人在治疗过程中均安全，胆道支架放置术疗效显著，黄疸消除率为70．8％，平均支架维持通畅时间为8．6个月，半年和一年生存率为62．5％和16．7％。结论：胆道支架放置术在治疗恶性梗阻性黄疸有较好疗效，使用安全。     

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。     

支架置入术治疗恶性低位胆道梗阻的临床价值

目的 探讨金属胆道支架置入术治疗恶性低位胆道梗阻的有效性、安全性.方法 32例恶性胆道低位梗阻患者(中位年龄61岁),术前经CT和磁共振胰胆管造影(magnetic resonance cholangiopancreatography,MRCP)证实为恶性胆道低位梗阻.其中,胆管癌12例,胰头癌11例,壶腹癌5例,转移癌2例,胆囊癌2例.32例患者行经皮经肝胆道穿刺,于胆总管中下端置入32枚自膨式金属胆道支架.结果 32例患者手术成功率100.0％,支架位置良好,胆汁引流通畅.术中无胆道出血、胆汁渗漏及胆道破裂等严重并发症.32例患者于术后7天复查肝功能,其血清总胆红素(total bilirubin,TB)由术前的(378.11±134.53) μmol/L下降至(166.10 ±74.37) μmol/L(P＜0.05);血清直接胆红素(direct bilirubin,DB)由术前的(219.14±86.37) μmol/L下降至(98.26 ±53.68) μmol/L(P＜0.05).29例于术后30天复查肝功能,其血清TB由术前的(356.78±118.21) μmol/L下降至(56.10±44.37)μmol/L;血清DB由术前的(219.14 ±86.37) μmol/L下降至(38.26±43.68) μmol/L,均P＜0.05.30例获得随访,随访1-42月(平均25.4月),9例再发支架内梗阻(30.0％),其中4例再行支架治疗,3例行导管引流治疗,2例未治疗死亡.十二指肠梗阻1例,行十二指肠支架治疗后缓解.生存期1-33月,平均生存期(11.56±2.14)月,中位生存期10.0月.结论 金属胆道支架置入术是治疗恶性低位胆道梗阻的安全、有效的方法.     

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.     

PTBD及PTIBS治疗胆道恶性梗阻的临床研究

目的：探讨经皮经肝胆管引流术（percutaneous transhepatic biliary drainage,PTBD）和经皮经肝胆管内支架引流术（percutaneous transhepatic insertion of biliary stent,PTIBS）治疗恶性梗阻性黄疸的技术,疗效及并发症。方法：172例恶性胆道梗阻患者在影像监视下行PTBD或PTIBS,术后10天复查血清总胆红素和直接胆红素。结果：172例恶性胆道梗阻患者,行外引流者123例,行内外引流者34例,行胆道支架置入者15例。技术操作成功率100%。所有患者术后第10天血清总胆红素和直接胆红素明显下降,肝功能改善,差异有统计学意义（P〈0.005）。结论：PTBD和PTIBS是治疗恶性梗阻性黄疸的有效方法,具有创伤小、操作简便、安全性高的优点。     

Safety of biliary stent placement followed by definitive chemoradiotherapy in patients with pancreatic cancer with bile duct obstruction

BackgroundAlthough patients with malignant bile duct obstruction due to pancreatic cancer are often initially treated with biliary stent placement, concurrent chemoradiotherapy with stents poses a potential risk of increased toxicity. This retrospective study aimed to evaluate the safety of biliary stent placement followed by definitive concurrent chemoradiotherapy in patients with pancreatic cancer.MethodsPatients with pancreatic cancer who underwent either a plastic stent or a self-expanding metallic stent placement for malignant bile duct obstruction before definitive concurrent chemoradiotherapy were retrospectively reviewed. Radiotherapy was delivered in 1.8 Gy per fraction to a total dose of 50.4 Gy. Gemcitabine, TS-1 plus Gemcitabine, or TS-1 was the concurrent chemotherapy/regimen. The primary endpoint was the rate of biliary stent-related toxicities, defined as biliary bleeding, duodenal perforation, or bile duct perforation.ResultsThirty patients were included. Plastic stents were placed in 23 patients and self-expanding metallic stent in seven patients at the start of irradiation. The median follow-up time was 20 (range, 2–63) months, and 27 patients (90%) completed concurrent chemoradiotherapy. Biliary stent-related toxicity (grade 3 biliary bleeding) was confirmed in one patient (3%) with a plastic stent 9 months after concurrent chemoradiotherapy. The median duration of locoregional control, progression-free survival, and overall survival were 31.1, 7.3, and 10.5 months, respectively.ConclusionsStent placement followed by concurrent chemoradiotherapy was not associated with an apparent increase in toxicity and may be an appropriate treatment for patients with locally advanced pancreatic head cancer with bile duct obstruction.     

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。     

恶性高位胆道梗阻经皮经肝胆道引流方式的疗效分析

目的：探讨恶性高位胆道梗阻患者经皮经肝胆道引流方式对术后近远期疗效影响,为临床选择适当的治疗方式提供依据。方法-回顾性分析我院108例恶性高位胆道梗阻患者,比较单侧引流（68例）和双侧引流（40例）,左右肝管是否相通,引流材料对近期胆红素下降值和生存情况的影响。结果：三组术后3—5天胆红素的下降值明显,但无统计学差异（P〉0．05）。随访1—36个月,单侧组和双侧组、单枚引流管与单枚支架生存率没有显著差异（P〉0．05）。结论：恶性高位胆道梗阻以右侧入路单侧引流为主,生存期预计大于3个月,放置胆道支架,否则置入胆道引流管。     

Endoscopic stent for palliating malignant and benign biliary obstruction

Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included papliila of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4),choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1).The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%,58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively.Early complication included post-ERCP panereatitis and eholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient‘s living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.     

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...     

Malignant biliary obstruction: From palliation to treatment

Malignant obstruction of the bile duct from cholangiocarcinoma, pancreatic adenocarcinoma, or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery. The optimal treatment - including the decision whether to treat prior to resection - depends on the type of malignancy, as well as the stage of disease. Preoperative biliary drainage is generally discouraged due to the risk of infectious complications, though some situations may benefit. Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure. For pancreatic cancer patients, self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion. For cholangiocarcinoma patients, treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement, with less risk of infectious complications or failure. For patients of either malignancy who have advanced disease with palliative goals only, the choice of stent for endoscopic decompression depends on estimated survival, with plastic stents favored for survival of < 4 mo. New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor. Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction.