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...

An Analysis of the Re-obstruction Factors and the Effective Interventional Treatments for Metallic Biliary Stents Placement Patients with Hilar Cholangiocarcinoma

Objective To retrospectively study the factors of re-obstruction after metallic biliary stents placement in patients due to hilar cholangiocarcinoma and its effective interventional treatments.Methods A total of 13 cases for re-obstruction after metallic biliary stents placement were studied. CT were performed in 8 cases and MR were performed in 5 cases. Percutaneous transhepatic cholangio-drainage(PTCD) were performed in all cases and percutaneous metallic biliary stents replacement were performed in 5 cases using 5 stents. And we studied 6 cases who performed transcathater arterial chemo-infusion by using 5-FU or Gemza(gemcitabine).Results The main factors of re-obstruction after metallic biliary stents placement may be tumor overgrowth towards the stent or ingrowth into the stent and formed biliary sands and infections. All patients survived PTCD and stent replacement without mortality. After a 30 months follow-up, the survival rate of 6 months, 1 year and 2 years was 100%, 75% and 33.3% , respectively.Conclusion There are many factors for re-obstruction after metallic biliary stents placement in patients due to hilar cholangiocarcinoma. Combined with continuously arterial chemo-infusion, PTCD and stents replacement were safe and effective and would be better for patients and prolong life of patients.