恶性梗阻性黄疸介入治疗术后并发胆道感染的相关因素分析

目的：探讨经皮肝胆管引流术（PTBD）或经皮肝胆管内支架引流术（PTIBS）治疗恶性梗阻性黄疸术后并发胆道感染的相关因素。方法共157例恶性梗阻性黄疸患者首次采用 PTBD 或 PTIBS 介入治疗,分类对比临床发病特征、手术方式和术后观察资料。结果共23例恶性梗阻性黄疸介入术后并发胆道感染,发生率14.6％。多因素分析显示,术前胆道感染病史、术前黄疸天数、低位梗阻、不全梗阻、支架累及 Oddis括约肌、术后胆汁引流不畅是造成术后胆道感染发生的相关因素（P＜0．05）。结论术前详细了解病史、依据梗阻平面和程度合理选择介入治疗方法、加强术后观察,能够降低恶性梗阻性黄疸介入术后胆道感染的发生率。     

经皮经肝穿刺胆管内外引流对胰腺的影响

目的评价经皮经肝穿刺胆管引流(PTBD)对胰腺的影响。资料与方法对110例梗阻性黄疸患者行PTBD内外引流和胆总管下段经壶腹放置支架,观察患者术前术后血淀粉酶(AMY)的变化,64例高位胆管梗阻行内外引流和46例低位胆管梗阻行支架治疗,比较两者胰腺炎的发生率。结果AMY升高者占44.5%(49/110),35例AMY>3倍正常值,引流组胰腺炎的发生率明显高于支架组(χ2=13.625,P<0.001)。结论胰腺损伤和胰腺炎是PTBD较常见的并发症,胰腺损伤与引流管或支架是否通过壶腹有关。     

Efficacy of interventional radiology in the management of portal hypertension: A narrative review

Portal hypertension is associated with numerous adverse effects, including the formation of gastroesophageal varices and a portal vein general circulation shunt. Portal hypertension can lead to portal blood flow into the liver and a subsequent reduction in liver function. Clinical interventions can be hampered by a concurrent reduction in circulating platelets associated with increased splenic activity. Pharmaceutical interventions for the treatment of complications associated with portal hypertension have achieved various degrees of success. However, an effective therapeutic strategy for portal hypertension has not yet been established. A literature search was performed using “PubMed.” Database between 1966 and January 2021 using the following keywords: portal hypertension, interventional radiology, balloon-occluded retrograde transvenous obliteration, transjugular retrograde obliteration of gastric varices, percutaneous transhepatic obliteration, partial splenic embolization, and transjugular intrahepatic portosystemic shunting. In this narrative review, we summarize the application of interventional radiology in patients with portal hypertension, including techniques for embolization of collateral veins and portal pressure reduction. These up-to-date interventional radiology techniques can be used to treat portal hypertension. The data that support the findings of this study are available from the corresponding author, upon reasonable request.     

Percutaneous transhepatic obliteration for life-threatening bleeding after endoscopic variceal ligation in a patient with severe esophagogastric varices

We report a case of life-threatening bleeding after endoscopic variceal ligation (EVL) in a patient with severe esophagogastric varices that was treated by percutaneous transhepatic obliteration (PTO). 3D-CT reconstruction image demonstrated giant esophagogastric varices and gastrorenal shunt. The spleen volume was 813 mL, and the liver volume was 716 mL; giving a spleen/liver volume ratio of 1.1. A strategy of stepwise partial splenic artery embolization (PSE) was employed to control portal venous pressure based on the concept of splanchnic caput Medusae. The S/L ratio improved to 0.3 by stepwise PSE. Subsequently, EVL was performed for esophageal varices, but bleeding occurred afterward, and hemostasis using a Sengstaken-Blakemore tube was attempted. Subsequently, PTO was performed the following day for embolization of the left gastric vein. Gastric varices and gastrorenal shunt were intentionally reserved to avoid portal venous pressure increase. After the procedure, his condition improved. We conclude, in patients with severe esophagogastric varices, prudent management of the splenomegaly and the collateral tracts is necessary.     

超声造影早期检出联合间充质干细胞治疗改善肝移植术后胆道缺血预后的初步探讨

目的  探讨超声造影（CEUS）早期检出联合间充质干细胞（MSC）治疗肝移植术后胆道缺血的疗效。方法  回顾性分析9例肝移植术后4周内CEUS提示胆道缺血且术后1年内确诊为非吻合口胆管狭窄（NAS）受者的临床资料。常规治疗组4例,行常规治疗,治疗方式包括护肝、利胆、介入治疗等; MSC治疗组5例,在常规治疗的基础上,分别于CEUS提示胆道缺血后1、2、4、8、12和16周接受MSC静脉输注。分析两组受者肝移植术后1年内介入治疗情况和预后。结果  MSC治疗组2例受者需接受介入治疗,首次治疗时间为肝移植术后7~9个月,治疗次数1~2次; 常规治疗组所有受者均需接受介入治疗,首次治疗时间早于MSC治疗组,为术后1~3个月,治疗次数2~6次。肝移植术后1年内,MSC治疗组2例受者发生弥漫性胆管损伤,未发生移植物失功; 常规治疗组所有受者均发生弥漫性胆管损伤,2例受者发生移植物失功。结论  应用CEUS早期检出肝移植术后胆道缺血并进行MSC治疗可延缓并减少NAS介入治疗需求,改善受者预后。     

超声引导下经皮肝胆管穿刺置管引流术治疗恶性阻塞性黄疸的临床价值

目的探讨在超声引导下经皮肝胆管穿刺置管引流术(PTCD)对恶性阻塞性黄疸的临床价值。方法回顾性分析13例恶性肿瘤所致的阻塞性黄疸患者,在普通彩超仪3．5MHz凸阵探头引导下行PTCD术。结果13例患者共行14次PTCD,其中1例左叶置管后滑出改行右前支穿刺置管,1例因肝内胆管内径小于4mm,穿刺失败后选用经皮肝胆囊穿刺置管,手术成功率92．8%(13／14),术后观察黄疸明显消退。结论在超声引导下行PTCD对不宜手术的恶性阻塞性黄疸病人是较好的选择,它具有灵活、简便、创伤小、疗效确切,值得临床推广应用。     

经皮肝穿刺植入可回收金标在射波刀追踪治疗的实验研究

目的评估一种肝脏金标植入新方法在兔肝脏内固定及取出的可行性, 以期用于射波刀金标追踪治疗。方法分为活体实验和离体实验。活体实验对10只家兔麻醉后, 经皮肝穿刺植入3颗金标, 10 d后植入设有外置套管和固定细线的第4颗金标, 以射波刀分别对参照组(第1颗和第2颗)和套管组(第1颗和第4颗)配准后追踪, 施照结束后, 评估金标植入成功率、配准精度及取出的安全性。离体实验在离体的肝脏进行金标拉力测试, 测量弹簧圈金标和无弹簧圈金标取出时所受阻力。结果实验过程中金标没有出现远处转移的情况, 植入与回收成功率均为100%。操作过程家兔未发生明显相关并发症和术后并发症。所有金标均成功追踪, 套管组的配准平移偏差在头脚方向和前后方向高于参照组(Z=-11.77、-4.57, P<0.05), 而左右方向低于参照组(Z=-2.52, P<0.05)。金标拉力测试结果显示弹簧圈金标拉力为(2.23±0.85)N,无弹簧圈金标拉力为(0.81±0.13)N, 差异有统计学意义(Z=-2.31, P<0.05)。结论螺旋线圈结构金标在穿刺针道内的固定效果好, 细线限制了金标肝外远处移位,...     

以ALATS球囊行经皮经肝十二指肠乳头肌扩张顺行排石术治疗胆总管结石

目的 观察以14 mm ALATS球囊行经皮经肝十二指肠乳头肌扩张顺行排石术（PTPBD）治疗胆总管结石（CBDS）的效果及其安全性。方法 回顾性分析40例接受直径14 mm ALATS球囊PTPBD治疗的CBDS患者，其中5例合并肝内胆管结石；CBDS最大径8~29 mm，19例最大径<14 mm （小结石组），21例≥14 mm （大结石组）。记录技术成功率、推石时间、围手术期并发症及不良反应。结果 38例（38/40，95.00%）技术成功、2例技术失败，组间差异无统计学意义（P=0.269）；推石时间16~62 min，平均（31.83±10.84） min。38例技术成功者中，术后6 h 30例诉轻度疼痛，6例感中度、2例诉重度疼痛，经对症治疗后均于48 h内缓解。围手术期未见胆管或肠管穿孔、胰腺炎等并发症。结论 直径14 mm ALATS球囊用于PTPBD治疗CBDS效果较好且安全。