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.

Biliary metallic stent placement for malignant low level biliary obstruction

Objective To evaluate the efficacy of biliary metallic stent placement for malignant low level biliary obstruction. Methods Thirty-two patients with malignant low level biliary obstruction were confirmed by CT and magnetic resonance cholangiopancreatography（MRCP） ,including 12 cases of bile duct carcinoma, 11 cases of carcinoma of pancreas head,5 cases of periampullary carcinoma,2 cases of carcinoma of gallbladder and 2 cases of metastatic cancer. The biliary metallic stents were placed in the middle/distal bile duct with percutaneous transhepatic cholangiography. Results All stents were successfully placed with bile duct patency. There were no hemobilia, leakage or rupture of bile tract. The TB （ total bilirubin ） in 32 cases dropped from （ 378. 11 ± 134. 53 ） μmol/L to （ 166. 10 ± 74. 37 ） μmol/L （ P 〈 0. 05 ） 7 d after operation,and the TB in 29 cases dropped from （356.78 ± 118.21 ） μmol/L to （56. 10 ±44. 37） μmol/L（P 〈0. 05 ） 30 d after operation, respectively. Thirty patients were followed up for 25.4 months on average （ 1 - 42 months） ; 9 patients （30. 0% ） had bile duct reocclusion in stents,among whom 7 were treated with percutaneous tranhepatic drainage or stent implantation and 2 died. The average survival time was （ 11.56 ± 2. 14 ） months （ 1 - 33 months）. Conclusion Metallic biliary stent implantation is a safe and effective method for treatment of malignant low level biliarv obstruction.