经皮肝穿与内镜联合放置内支架治疗恶性胆道梗阻

目的 探讨恶性胆道梗阻时，提高胆管内引流的成功率和置管准确性的方法。方法 经内镜逆行胰胆管造影（ERCP）不成功者12例，行X线或B超下经皮经肝胆管穿刺或置管引流术（PTCD），通过经皮经肝的引流管插入导丝至十二指肠，内镜借助导丝胆管插管，最终在内镜下放置内支架，根据病变部位和转移程度选择塑料内支架（TS）还是金属内支架（EMS）以及支架的长度。结果 12例全部成功。放置TS8例，放置EMS4例。未发现与操作相关的特殊并发症。结论 内镜ERCP与经皮肝穿联合放置内支架治疗恶性胆道梗阻，可以提高插管成功率和置管的准确性。

Treatment of malignant biliary obstruction by locating stents through combination of percutaneous transhepatic and endoscopic ERCP

[Objective] To find out how to increase the percentage of success in the biliary drainage and the probability of locating the catheter intubation precisely for malignant biliary obstruction. [Methods] In treating the patients with malignant biliary obstrusion by ERCP, there are 12 failing cases, However, under X-rays and ultrasonic therapy, through the percutaneous transhepatic biliary drainage or PTCD,a conductor is inserted to the duodenum, with the help of the conductor, endoscopic catheter intubation is easily realized. At last, stents are located properly under the endoscopy. Whether plastic stents or metallic stents should be used as well as how long the stents should be all depend on the position and the movement of the biliary obstruction. [Results] All of the 12 cases are successful. 8 cases are with TS, and 4 cases are with EMS. No special adverse events related to the operation are found. [Conclusions] Treatment of malignant biliary obstruction by locating the stents through the combination of percutaneous transhepatic and endoscopic ERCP can increase the percentage of success in making the biliary catheter intubation and the probability in locating the catheter intubation precisely for the treatment of malignant biliary obstruction.