经皮肝穿刺胆道造影引流术治疗67例老年恶性梗阻性黄疸的效果观察

为观察和评估经皮肝穿刺胆道造影引流术(PTCD)对老年性梗阻性黄疸的临床疗效,分析67例恶性梗阻性黄疸的老年患者常规经皮肝穿刺胆道造影后放置外引流管或留置内支架及引流管临床资料,观察治疗前后血清总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL)的变化。结果62例病人均经皮经肝穿刺手术成功。PTCD治疗后TBIL、DBIL和IBIL均较治疗前下降(P<0.05)。PTCD治疗老年性恶性梗阻性黄疸具有创伤小、安全、有效的优点,是姑息性治疗的有效方法。     

两种不同途径胆道支架置入术治疗恶性梗阻性黄疸的临床疗效评价

目的对比经内镜逆行性胰胆管造影术(ERCP)与经皮肝穿刺胆道引流术(PTCD)治疗恶性梗阻性黄疸(MOJ)病人的临床疗效。方法回顾性分析MOJ病人113例临床资料,按照支架置入途径分为ERCP组48例和PTCD组65例。比较2组手术成功率、临床疗效、术后并发症、住院时间及住院费用。结果ERCP组与PTCD组总体手术成功率、高位及低位梗阻的手术成功率、黄疸总体缓解率、并发症发生率、住院费用差异均无统计学意义(P>0.05)。ERCP组高位梗阻黄疸缓解率、病人住院时间均低于PTCD组(P < 0.05)。ERCP组低位梗阻黄疸缓解率高于PTCD组(P < 0.05)。结论ERCP与PTCD治疗MOJ病人具有显著临床疗效,ERCP对于低位梗阻更有优势,PTCD对于高位梗阻更具优势。临床医师需结合病人具体情况选择ERCP或PTCD。     

不同途径胆道金属支架置入治疗不同类型恶性阻塞性黄疸的临床对比研究

目的：对比不同途径胆道金属支架置入治疗不同类型恶性阻塞性黄疸的临床效果。方法方便选取2011年1月—2015年10月在该院行胆道金属支架置入治疗的MOJ患者150例,其中经ERCP途径50例(ERCP组）,经PTCD途径100例(PTCD组）。对比两组的手术成功率、有效率、术后并发症发生率、住院时间。结果高位梗阻中ERCP组有效率明显低于PTCD组,差异具有统计学意义(P<0.05）;ERCP组总并发症发生率明显低于PTCD组,差异具有统计学意义(P<0.05）;低位梗阻中和ERCP组并发症发生率低于PTCD组,差异具有统计学意义(P<0.05）。结论经ERCP和经PTCD途径胆道金属支架置入治疗MOJ均可取得显著的临床疗效,对于低位梗阻患者而言经ERCP更有优势,对于高位梗阻患者而言经PTCD途径更有优势。     

经内镜逆行胆道支架置入术与经皮经肝穿刺胆道支架置入术姑息治疗肝门胆管癌的疗效对比

目的：对比分析经内镜逆行胆道支架置入术与经皮经肝穿刺胆道支架置入术姑息治疗肝门胆管癌的临床疗效。方法收集肝门胆管癌患者77例作为研究对象,随机分为试验组（34例）与对照组（33例）,试验组患者采用经皮经肝穿刺胆道支架置入术治疗,对照组采用内镜逆行胆道支架置入术治疗,对2组患者的肝功能情况及并发症发生情况进行分析对比。结果2组患者肝功能情况比较TBIL、γ-GGT、ALP、ALT差异无统计学意义,但是DBIL方面实验组明显低于对照组(P<0.05);接受治疗后,试验组患者各项凝血指标稳定情况明显优于对照组,组间对比差异有统计学意义（P<0.05）;试验组不良反应发生率为20.59%,对照组为45.45%,试验组不良反应发生率明显低于对照组(P<0.05)。结论对肝门胆管癌患者采用经皮经肝穿刺胆道支架置入术治疗可有效降低并发症发生率,值得在临床应用上推广。     

经内镜逆行胰胆管造影术与经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的比较

目的 探讨经内镜逆行胰胆管造影术(ERCP)与经皮肝穿刺胆道引流术(PTCD)治疗恶性梗阻性黄疸的临床效果,为临床选择术式提供参考。 方法 选择140例恶性梗阻性黄疸患者,按照治疗术式分为ERCP组与PTCD组。对比2组患者手术成功率、黄疸缓解率、并发症、治疗成本及相关临床指标。 结果 ERCP组与PTCD组低位梗阻及高位梗阻手术成功率分别为94.74% vs. 71.43%、84.21% vs. 100.00%,对比差异均有统计学意义(P＜0.05);ERCP组与PTCD组低位梗阻及高位梗阻黄疸缓解率分别为98.25% vs. 78.57%、68.42% vs. 92.00%,对比差异均有统计学意义(P＜0.05);两组ALT、DBIL、TBIL术后2周与术前均有明显改善,对比差异有统计学意义(P＜0.05);ERCP组与PTCD组,整体并发症发生率为5.26% vs. 17.19%,对比差异有统计学意义(P＜0.05),ERCP组与PTCD组低位梗阻黄疸并发症发生率分别为1.75% vs. 28.57%,对比差异有统计学意义(P＜0.05);ERCP组与PTCD组住院时间、手术费用、治疗费用分别为(13.54±2.54)d vs. (20.14±3.38)d、(2.62±0.15)万元 vs. (2.15±0.41)万元、(4.82±0.69)万元 vs. (5.04±0.71)万元,住院时间、手术费用对比差异有统计学意义(P＜0.05)。 结论 ERCP与PTCD治疗恶性梗阻性黄疸均可以取得较好的临床效果,低位梗阻首选ERCP治疗,高位梗阻首选PTCD治疗。      

胆管支架置入联合肿瘤动脉灌注化疗治疗恶性梗阻性黄疸疗效观察

目的探讨胆管支架置入联合肿瘤动脉灌注化疗术治疗恶性梗阻性黄疸的疗效。方法回顾性分析2006年1月至2012年6月该院收治的410例失去手术机会或不愿意手术的恶性梗阻性黄疸患者并成功接受胆道支架置入,单纯放置胆管支架254例(对照组),胆道支架联合肿瘤动脉灌注化疗术156例(观察组)。观察两组患者黄疸、肝功改善情况、胆道支架通畅时间、患者生存时间。结果两组患者1周后TBIL、DBIL和ALB水平均较治疗前显著下降(P<0.05),两组间比较差异无统计学意义(P>0.05);观察组胆道支架通畅时间及患者生存时间均明显长于对照组,差异有统计学意义(P<0.05)。结论胆管支架置入联合肿瘤动脉灌注化疗术治疗恶性梗阻性黄疸能有效延长胆道支架通畅时间,显著提高患者的生存质量,延长生存时间,值得临床推广应用。     

DSA介入引导经皮肝穿刺胆道引流术联合胆道内支架治疗高危胆道恶性梗阻35例效果观察

目的:探讨DSA介入引导经皮肝穿刺胆道引流术(PTCD)联合胆道内支架治疗高危胆道恶性梗阻的临床效果。方法:筛选胆道恶性梗阻患者35例作为研究对象。所有患者采用DSA介入引导经皮肝穿刺胆道引流术联合胆道内支架进行治疗,比较术前与术后患者的血清胆红素等指标,并统计术后并发症发生情况。结果:35例患者一次性穿刺及支架置入成功,成功率为100.00%。试验室检验结果表明术后7 d、14 d与术前血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)指标比较,差异有统计学意义(P<0.05)。术后1个月内发生胆道感染2例(5.71%),急性胰腺炎3例(8.57%),支架脱落移位1例(2.86%),无胆汁性腹膜炎及其他并发症发生。结论:DSA介入引导经皮肝穿刺胆道引流术(PTCD)联合胆道内支架治疗高危胆道恶性梗阻可显著缓解黄疸症状,术后并发症发生率较低,较单纯超声定位模式具有穿刺准确的优势,临床治疗效果及应用价值值得肯定。     

经皮肝胆管穿刺引流术加胆管支架置入术治疗恶性梗阻性黄疸

目的:探讨经皮肝胆管穿刺引流术(PTCD)加胆道支架置入术治疗恶性梗阻性黄疸(MOJ)的临床应用价值。方法:分析130例行PTCD加胆道支架置入术的MOJ患者的临床资料,进行临床观察。结果:手术技术成功率达97.7%;术后肝功能较术前明显改善(P<0.05);术后并发症有胆道感染、急性胰腺炎及支架脱落等,经治疗后均好转;17例患者因肿瘤进展及多脏器功能衰竭死亡,中位生存期8.7个月。结论:PTCD加胆道支架置入术治疗MOJ安全有效,但术后需注意并发症的预防与治疗。     

PTCD并胆道支架对恶性梗阻性黄疸治疗价值

提要目的探讨PTCD(经皮经肝胆管引流术)并胆道支架种植术对恶性梗阻性黄疸的治疗效果。方法回顾性分析近3年来我院所开展的PTCD并胆道支架种植20例患者的临床资料。结果穿刺成功率100%。全部患者未出现出血、胆道漏、胆汁性腹膜炎等并发症。患者随诊最长时间14个月。结论PTCD并支架种植术是一种较好的姑息治疗梗阻性黄疸的有效方法。对不宜手术或无手术机会的患者是最佳的选择。     

介入治疗复发恶性阻塞性黄疸的临床分析

目的 探讨超声辅佐下经皮经肝胆管引流术(PTCD)并胆道支架种植术对复发恶性梗阻性黄疸的治疗效果.方法 回顾性分析复发恶性梗阻性黄疸超声辅佐下PTCD并胆道支架置入24例患者的临床资料.结果 其中21例成功行PTCD并胆道支架种植术,3例行单纯PTCD.4例患者出现出血(腹腔出血,胆道出血),1例出现肝功能衰竭,无胆漏、胆汁性腹膜炎等并发症.结论 PTCD并支架置入术是一种较好的姑息治疗梗阻性黄疸的方法,对无手术机会的复发恶性梗阻患者是较好的选择.     

Computed tomography of biliary cystadenoma and biliary cystadenocarcinoma

INTRODUCTION: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary ductal neoplasms of the liver. This study aims to describe the computed tomography (CT) findings of these neoplasms and to distinguish between both entities. METHODS: We retrospectively reviewed the CT findings of five patients with proven BCA and seven patients with proven BCAC at our institution from July 2000 to August 2006. The CT parameters were analysed, including number, size, location, and characteristics of the cystic lesion: presence and number of internal septation, calcifications and enhanced mural nodule. RESULTS: All 12 patients had a solitary, large well-defined intrahepatic cystic lesion. Lesions in all five patients with proven BCA (100 percent) and six patients with proven BCAC (86 percent) had a multilocular appearance. The remaining patient with proven BCAC had a unilocular lesion. Smooth, thin septa and walls were found in five patients with BCA (100 percent). The enhanced mural nodule at the septum or wall was identified in seven patients with BCAC (100 percent) but was not found in the BCA patients (p-value is less than 0.001). The other parameters including size, location and number of septa had no statistically significant differences between BCA and BCAC. CONCLUSION: BCA and BCAC should be considered in the differential diagnosis, when a solitary large well-defined multilocular intrahepatic cystic lesion is detected in a middle-aged woman. The presence of an enhanced mural nodule is the most important finding to suggest BCAC.     

可膨式金属胆道支架治疗胆道恶性梗阻

恶性肿瘤引起的梗阻性黄疸 ,多需外科手术治疗。但有许多患者就诊时已不能作根治性切除术〔1〕。近年来兴起的经内镜胆道金属支架引流术(ＥＭＢＥ) ,可为该类患者解除胆道梗阻 ,减轻黄疸 ,延长生存时间及提高生存质量〔2〕。我院采用可膨式金属胆道支架治疗 5例 ,现报告如下。1　临床资料1 .1　一般资料　本组 5例 ,其中男 4例 ,女 1例 ,年龄 60～ 73岁 ,平均 69.2岁。术前均有明显黄疸 ,总胆红素 3 0 0～ 5 2 0 μｍｏｌ/Ｌ。术前均行Ｂ超、ＣＴ、ＭＲＣＰ等检查 ,其中 2例诊断不明。 5例中肝门部胆管癌 3例 ,胆囊癌转移压迫肝门部 1例 ,胃…     

The Effects of Cholecystojejunostomy and Biliary Drainage on Biliary Motor

Summary: Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, ery thromycin 10 mg/kg, atropine 3 μg/kg and L-NAME 10 mg/kg respectively. Each rabbit under went manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was in creased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and con traction amplitude, CCK increase basal pressure contraction amplitude and frequency, and ery-thromycin increase contraction amplitude, respectively. But comparing with that before cholecystoje junostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal fac tors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.     

Clip-induced biliary stone

Surgical clip migration is a well-known phenomenon ever since their first use in surgery. The mechanism of clip migration is poorly understood, and can occur from days to years after laparoscopic cholecystectomy. Migration of the surgical clips may be a complex process involving necrosis, pressure exerted from intra-abdominal movement, formation of stones over the exposed clip within the bile duct, and eventual migration into the common bile duct. We report two cases, a 58-year-old man and a 54-year-old woman, of clip- induced biliary stones resulting from surgical clip migration a few years after laparoscopic cholecystectomy.     

超声内镜引导下胆管引流在恶性胆管梗阻中的研究进展

恶性胆管梗阻（MBO）因胆汁排泄障碍引起梗阻性黄疸,可能导致胆管炎、脓毒血症、肝衰竭等并发症,甚至危及患者生命,胆管引流是解除症状、改善患者生活质量的有效手段。目前,对于无手术机会的MBO患者,经内镜逆行胰胆管造影（ERCP）置入金属支架是姑息性治疗的一线方法。近年来,对ERCP失败的MBO,超声内镜引导下胆管引流（EUS-BD）技术逐渐被接受,认为是优于经皮经肝穿刺胆管引流术（PTBD）的替代方法。有证据表明,由经验丰富的术者操作,对于远端MBO患者,EUS-BD甚至可以作为一线治疗方法替代ERCP。本文就EUS-BD在MBO中的研究进展进行综述。