经皮经肝胆管引流及胆管支架置入术后严重并发症的介入处理

目的 回顾性分析经皮经肝胆管引流及胆管支架置入术后严蕈并发症的介入处理方法 .方法 对中山大学肿瘤防治中心113例恶性胆管梗阻的患者行经皮经肝引流和置入金属内支架,13例出现严重并发症或采取特殊处理手段成功处理并发症.4例发生引流管部分滑脱并盘曲于肝脏与腹壁之间,4例支架放置位置过低或下移进入十二指肠腔造成小肠梗阻,5例术后经引流管引流出大量血性液体.结果 4例引流管滑脱患者,2例在CT扫描定位下、2例在DSA透视下成功实施胆道穿刺针固定引流管肝内部分后拉直盘曲部分并在导丝配合下将滑脱部分顺利推送入胆道系统;4例支架低位进入十二指肠造成小肠梗阻者,其中3例通过内镜顺利经口腔取出并在内镜直视下重新放置支架,1例取出支架后因患者拒绝再次放置支架而采取鼻胆管引流;5例引流出大量血性液体者经栓塞出血血管或置入带膜血管支架封堵血管瘘口后均成功止血.结论 经皮经肝胆管引流及胆管支架置入术后严重并发症应采取积极态度和手段应对以改善患者的预后.

Interventional management of severe complications after percutaneous transhepatic choleric drainage and percutaneous implantation of biliary slants

Objective To evaluate the efficacy of interventional management in treatment of severe complications after percutaneous transhepatic cholangiography and percutaneous implantation of biliary stents. Methods Percutaneous biliary drainage and implantation of biliary stents for malignant biliaryobstruction under fluoroscopic guidance was performed in 113 patients. Thirteen of them developed severe complications: drainage catheter slipping and locating between liver and abdominal in 4 cases, bowl obstruction due to lower implantation or slipping of stent into the duodenum in 4 cases, and plenty of bloody drainage in 5 cases. Results For the 4 cases of drainage catheter slipping, under guidance of CT scan (2cases)or DSA fluoroscopy (2 cases), 21G needle was used to puncture the drainage catheter left in biliary tract in order to fix the catheter so as to avoid its continuous slipping. Then curved catheter located betweenthe abdominal wall and liver could be pulled straight and then advanced into the biliary tract again with the help of a guide wire. For the complication of bowl obstruction in 4 cases, stent was captured and pulled out through oral cavity and then a new stent was implanted back with the help of endoscopy in 3 eases. One patient refused to accept re-implantation of stent and had to undergo nasobiliary drainage. Complication of bloody drainage was successfully overcome by embolizing the bleeding blood vessel or implanting covered stent in the site of fistula caused by puncture in 5 cases. Conclusion Active attitude and methods should be adopted to cope with severe complications after percutaneous transhepatic biliary drainage and percutaneous implantation of biliary stents for better prognosis.