经皮胆道内支架置放术治疗胆道狭窄

目的：采用经皮肝穿胆道支架置入术治疗阻塞性黄疸并探讨其疗效、技术要点及并发症。材料与方法：２５例胆道狭窄接受经皮经肝胆道内支架置入术，其中胆管癌１６例，胰头癌４例，肝门区转移癌３例和胆道术后狭窄２例。结果：技术成功率为９６．０％。２例患者分别行右、左肝管双支架置入。恶性梗阻者６个月生存率为７３．３％，１２个月为４６．６％。６个月胆道再狭窄率为４０．０％。主要并发症为轻度胆道出血（４４．０％）和逆行感染（８．０％），经保守治疗痊愈。结论：结果显示本术治疗胆管狭窄安全有效，技术成功率较经ＥＲＣＰ途径高。配合动脉内化疗灌注可提高恶性阻塞患者的生存率。

Treatment of biliary stricture by percutaneous transhepatic insertion of metallic stent

Purpose: Percutaneous transhepatic insertion of biliary stent(PTIBS) was adopted for treating malignant and benign biliary stricture. The therapeutic effect, technique and complications were investigated. Materials and methods: Twenty five patients with biliary stricture were treated by PTIBS, including hilar biliary cancer 16 cases, pancreatic cancer 4 cases, hilar metastatic cancer 3 ca ses, and post operative biliary stricture of bile duct 2 cases. Results: The technical success rate was 96.0% (24/25). Two stents were placed in the right and left hepatic ducts respectively in 2 cases. The survival rate of 6 and 12 monthes were 73.3% and 46.6%. Restenosis rate was 40.0% in 6 months. Mild hemobilia (44.0%) and retrograde infection (8.0%) were the main complications which could be managed by conservative treatment. Conclusion: It was suggested that PTIBS was a safe and effective method in the treatment of biliary stricture. There was a higher success rate of PTIBS as compared to endoscopic retrograde biliary, approach especially in patients with hilar biliary stricturc. If combined with chemotherapy, the survival rate of malignant biliary stricture could be further improved.