胆道支架与十二指肠支架联合应用治疗胆道消化道梗阻

目的评价联合应用双支架治疗胆道及十二指肠梗阻的疗效。方法20例患者实施治疗。16例患者先经过经皮肝穿刺置入胆道支架解决胆道梗阻,患者出现十二指肠梗阻的症状后,14例患者经口腔、2例患者经胃造瘘口置入十二指肠支架。有4例患者同时有胆道和十二指肠梗阻的症状,同时置入胆道和十二指肠支架。结果所有患者都成功置入了双支架,没有出现并发症和再梗阻的表现。生存期1~14个月,平均5个月。结论联合双支架置入是治疗胆道和十二指肠梗阻的有效的方法。     

金属内支架置入术治疗胃十二指肠恶性梗阻

目的　探讨不能手术的胃十二指肠恶性梗阻金属内支架治疗方法和效果。方法　 67例胃十二指肠恶性梗阻 ,胃窦及幽门部梗阻 2 7例 ,十二指肠降段及以远梗阻 2 6例 ,胃十二指肠及胃空肠吻合口梗阻 14例 ,均在X线透视下采用介入放射学方法 ,经口腔共置入记忆合金网状内支架 84枚 ,其中 17例因支架置入 6个月后再梗阻又放置了第 2枚支架。结果　 67例患者支架置入成功后 ,梗阻症状迅速解除 ,当日即能进食。术后 1个月与术前比较 ,体重平均增加 4.7kg ,无严重并发症发生。随访 1～ 2 0个月均进食情况良好。结论　金属内支架置入术操作简单、微创、可重复 ,是无法手术治疗的胃十二指肠恶性梗阻首选有效的治疗方法。     

经皮肝途径联合置入胆道和十二指肠支架

作者报道了胆总管合并十二指肠恶性梗阻2例。例1,诊断为腹膜后平滑肌肉瘤,致十二指肠梗阻。先前曾作了胃空肠吻合术。经皮肝穿胆管造影示:胆总管中度扩张并十二指肠第二、三段狭窄及变形。例2,为直肠癌转移致十二指肠梗阻;造影示:肝总管和总胆管狭窄,及十二指肠第三段的狭窄。两者均失去手术根治机会,由于十二指肠受累,导致ERCP和内镜置入支架失败,而选经皮肝穿途径同时置入十二指肠和胆管内支架,缓解两处梗阻。     

恶性胆道梗阻内支架引流随访研究

目的评价支架置入治疗恶性胆道梗阻的临床效果及价值。方法对279例恶性胆管梗阻(高位梗阻127例,中低位梗阻152例)分别采用单点位单支架及双点位双通道双支架置入,单点位单通道双支架置入或单支架置入配合外引流的治疗方法。测定术前、术后血清总胆红素水平并进行t检验。结果273例术前、术后血清总胆红素水平比较差异显著(P<0.05)。生存满6个月218例(218/279,78%);生存6个月以上193例(193/279,69%);生存1年或1年以上131例(131/279,47%)。结论支架置入联合抗肿瘤治疗可提高病人生存率和降低支架再梗阻的发生。     

胆管内支架治疗肝门部胆管梗阻

目的 探讨肝门部胆管梗阻置入支架治疗梗阻性黄疸的可行性和操作方法.资料与方法 28例肝门部胆管梗阻患者经皮经肝穿刺,分别在左右肝管置入支架.经单侧穿刺5例,经左右肝分别穿刺23例.2枚支架并排放置21例,经第1枚支架网眼放置第2枚支架7例.结果 手术成功率100%,无与操作有关的严重的并发症发生,血胆红素术前(19.34±15.47) mg/dl,术后1周内下降为(9.75±8.21) mg/dl.生存期25～816天(平均213天).结论 通过介入手段置入胆管内支架是缓解肝门部梗阻引起的黄疸安全、有效的方法 .     

超声引导下PTCD与ERCP联合治疗恶性梗阻性黄疸十例

目的探讨超声引导下经皮经肝胆管穿刺引流(UG-PTCD)与内镜逆行胰胆管造影(ERCP)联合术解除恶性胆道梗阻的方法和效果。方法10例恶性胆道梗阻患者ERCP治疗失败后,立即行UG-PTCD,将导丝沿肝内胆管、胆总管引入十二指肠。与ERCP对接后,行胆道支架植入或行梗阻物理因素解除。结果 10例均获得成功。UG-PTCD与ERCP对接获得成功后的患者,术后血清胆红素明显下降。主要并发症为发热、血清淀粉酶升高和短暂血性胆汁。结论 UG-PTCD与ERCP联合治疗是解决ERCP失败后的一种新探索,具有良好的临床应用价值,可明显提高ERCP成功率。     

经皮肝穿胆道内支架置入术治疗恶性胆管梗阻

目的：探讨经皮肝穿胆道内支架置入术治疗恶性胆管梗阻的疗效及技术要点。方法：３５例恶性胆管梗阻采用经皮肝穿刺肝管胆道内支架置入术，其中胰头癌１３例，肝转移癌５例、肝门淋巴结转移压迫胆管７例、胆管癌１０例。结果：共置入３种４３枚金属内支架，其中８例采用双内支架，技术操作成功率１００％。术前血清总胆红素１７０．００～８６０．０ｕｍｏＩ／Ｌ，术后３１例降至１８．２～５３．６ｕｍｏＩ／Ｌ。半年以上生存率７７．１４％（２７／３５），１年以上生存率４８．５７％（１７／３５）。本组无严重并发症，轻度并发症未作特殊处理。结论：经皮肝穿胆道内支架置入术，是不能手术的恶性胆管梗阻安全、有效的治疗方法。配合动脉插管化疗可显著提高其疗效     

经皮肝途径胆道内支架置入术治疗恶性胆管梗阻(附57报告)

目的：经皮肝穿肝胆管内置入金属支架治疗恶性胆管梗阻并探讨其 点和影响疗效的因素。方法：57例恶性胆管梗阻，采用经皮肝穿刺肝管胆道内金属支架置入术，胆管癌25例，胰头癌9例，肝癌15例，胃癌转移8例。阻塞部位们于胆总管33例；肝门部24例，其中肝总管13例，累有右肝管5例，左、右肝管6例。结果：共置入4种类型金属支架65枚，9例病人置入双内支架。技术操作成功率98．2％。术前血清胆红素162．7－960．4μmol/l，术后53例降至18．3－55．6μmol/l。半年生存率75．4％（43．57），一年生存率47．4％（27／57）。支架置入后半年再 阻塞率43．9％（25／57）。结论：经皮肝穿胆道内支架置入术治疗恶必理管梗阻安全、有效，是临床重要姑息性治疗手段，支架再阻塞是影响远期疗效的重要因素。     

胆道内支架置入结合动脉化疗栓塞术治疗恶性胆道梗阻

目的探讨经皮肝穿刺胆道内支架置入术结合动脉化疗栓塞治疗恶性胆道梗阻的临床疗效。方法12例恶性胆道梗阻病人采用经皮肝穿刺胆道内支架置入术,2周后行供血动脉灌注化疗和/或化疗栓塞,每月一次。结果12例病人共放置国产网状支架14枚。11例病人血清胆红素水平由术前534±120μmol/L降至术后的45±23μmol/L。半年以上生存率83.3%,一年以上生存率50%,2例病人4个月后因胆管再次梗阻第二次置放支架。12例病人共行动脉化疗栓塞35次,显示了明确疗效。结论经皮肝穿刺胆道内支架置入术结合动脉化疗栓塞是治疗恶性胆道梗阻安全、有效的方法。     

经皮国产胆道金属内支架置入术治疗恶性梗阻性黄疸

目的:探讨国产胆道金属内支架的经皮经肝穿刺置入技术及其临床应用价值.方法:1996年7月～2006年10月经皮经肝穿刺胆道金属内支架置入术治疗恶性梗阻性黄疸患者167例.其中67例患者置人国产胆道金属内支架,男42例.女25例,年龄28～88岁.首先经皮经肝穿刺胆道造影,再选择性穿刺理想肝内胆管分支,送入导丝导管通过胆道梗阻段后导入硬交换导丝,沿该导丝送入球囊预扩张病变节段后置入胆道金属内支架,最后送入内-外引流管引流观察5天左右后撤出.结果:67例患者置入国产胆道金属内支架96枚,术中均未出现严重并发症,术后住院治疗5～10天.术后1个月复查血清总胆红素,均降至术前的1/2以下,44例降至正常范围.谷丙转氨酶、谷氨酸转肽酶均较术前显著下降.6个月生存48例,12个月生存14例,2例生存2年.结论:国产胆道金属内支架置入术治疗恶性梗阻性黄疸安全有效,价格低,治疗效果与进口胆道支架无明显差异.可明显缓解黄疸,减轻痛苦,提高生存质量,改善肝脏功能,延长生存时间.     

Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

Purpose The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42–80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting.     

胆肠双支架对胰头癌的姑息性治疗效果初探

目的探讨胆道内支架和十二指肠金属内支架联合应用治疗胰头癌的价值。方法2003年8月～2005年7月，对4例出现胆道梗阻的胰头癌患者先置入胆道内支架行减黄治疗，当其出现上消化道梗阻症状时，再置入十二指肠金属内支架，观察该治疗方法的疗效。结果4例患者的胆道和十二指肠内支架均一次置放成功。置入胆道内支架后，所有患者的胆红素水平在24h后下降50％左右，1周时均降到正常范围，黄疸消退。当胆道支架堵塞时，行支架置换术或再次置入支架，均成功减黄。置入十二指肠金属内支架后，患者的消化道梗阻症状得到缓解，可进食。当肠道梗阻再发时，再次置入十二指肠内支架。其中1例患者先后共置放3枚十二指肠金属内支架。4例患者均无支架置入术相关并发症发生。死亡2例，其中1例置入支架后生存24个月，1例生存22个月，直至临终均无黄疸及肠梗阻症状；另2例患者仍在随访中，1例置入支架术后16个月，1例9个月，目前均无黄疸及肠梗阻症状。结论胆道内支架联合十二指肠内支架可以明显改善胰头癌患者的生活质量，是一种有效的姑息性治疗方法。     

Expandable metallic biliary endoprostheses: preliminary clinical evaluation

A biliary endoprosthesis constructed of self-expanding metallic "Z" stents was placed in 23 patients with obstructive jaundice. The biliary obstruction was due to a malignant neoplasm in 21 patients and a postoperative biliary stricture in two patients. The lesions affected the intrahepatic biliary ducts in 13 patients. Twelve patients had undergone radiation therapy before stent placement. The endoprostheses consisted of 196 expandable metallic biliary stents placed singly (n = 10) or in tandem (n = 186). As many as 18 stents were used to relieve an obstruction in one patient. A transhepatic approach was employed in all patients except one in whom stents were placed through a T-tube tract. Within 1 week after placement, all stents expanded to at least 90% of their original diameter. Three misplaced, two deformed, and two dislodged stents caused no obvious clinical problems. At follow-up, which ranged from 2 to 59 weeks, five patients experienced recurrent jaundice. Two patients with recurrent jaundice due to obstruction of the bile duct containing the stent were treated with external catheter drainage. The expandable biliary endoprosthesis is suggested as an effective treatment for benign and malignant biliary obstruction.     

Acute Duodenal Obstruction After Percutaneous Placement of Metallic Biliary Stents: Peroral Treatment with Enteral Stents

Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention.     

经皮肝胆管穿刺金属内支架植入治疗恶性梗阻性黄疸

目的：探讨经皮肝胆管穿刺金属内支架植入治疗恶性梗阻性黄疸临床应用价值。方法：108例患者中的9r7例均采用X线透视下经皮肝穿刺胆道内支架植入术治疗恶性梗阻性黄疸。根据梗阻部位的不同解剖决定放置支架的方式。结果：108例患者中,90例植入单支支架于肝总管或（和）胆总管,7例植入2支以上支架于总管和分支胆管,11例行外引流。全部患者2周内血清胆红素从（436±314）mol／L降低到（53±31）mol／L。结论：经皮肝穿刺内支架植入是治疗恶性胆道梗阻性的有效方法。     

胆道支架位置对治疗低位恶性梗阻性黄疸的影响

目的 比较胆道支架跨与不跨十二指肠壶腹部放置治疗低位恶性梗阻性黄疸患者的临床预后差异.方法 分析本院符合条件的56例恶性梗阻性黄疸患者的临床资料,其中支架跨十二指肠壶腹部放置31例,支架不跨十二指肠壶腹部放置25例,比较2组患者间支架置入术后4~7 d总胆红素下降率、胆道感染率及支架再阻塞率等方面的差异.结果 跨壶腹部组与不跨壶腹部组的生存期分别为(180.3±142.5) d、(178.6±137.7) d(P=0.840).2组患者术后4~7 d总胆红素下降率为42.0%±43.6%、41.4%±28.7%(P=0.950);治疗成功率分别为93.5%、92.0%(P=1.0).跨壶腹部组术后胆道感染7例(22.6%),不跨壶腹部组术后胆道感染5例(20.0%)(P=0.815).2组患者支架再阻塞率分别为22.6%、28.0%(P=0.642).结论 2种支架置入方式均是治疗低位胆道梗阻安全、有效的方法;与支架非跨壶腹部放置相比,支架跨壶腹部放置未增加胆道感染及支架再狭窄发生率.     

Percutaneous unilateral placement of biliary covered metallic stent in patients with malignant hilar biliary obstruction and contralateral portal vein occlusion

Background Unilateral biliary metallic stent placement in the lobe with patent portal vein seemed to be a safe and effective palliative treatment of patients with contralateral portal vein occlusion caused by advanced hilar malignancy, obviating bilateral stent placement in these patients, because the hepatic lobe with portal vein occlusion ceases to produce bile due to interruption of enterohepatic circulation. Purpose To investigate the safety and efficacy of percutaneous unilateral expanded polytetrafluoroethylene (ePTFE)-covered stent placement in malignant hilar biliary obstruction with contralateral portal vein occlusion. Material and Methods From February 2008 to March 2011, 24 consecutive patients with malignant hilar biliary obstruction and unilobar portal vein occlusion were enrolled in this prospective study. All patients were treated by percutaneous placement of ePTFE-covered stents. Results Stent deployment was technically successful in all patients. Two (8%) patients experienced minor self-limiting hemobilia. No major complication was noted. Successful internal drainage was achieved in 22 (91.6%) patients. Mean serum bilirubin level, which was 12.5 mg/dl ± 8.4 before drainage, decreased significantly to 2.7 mg/dl ± 3.4, 1 month after stent placement (P < 0.001). Median survival was 191 days (95% CI, 94-288 days) and cumulative stent patency rates at 1, 3, 6, 9, and 12 months were 100%, 95%, 95%, 95%, and 71%, respectively. Two (8%) patients presented with stent occlusion due to sludge incrustation. Aside from two patients who had died within 30 days after stent placement, the other 22 patients demonstrated slight decrease in diameter of undrained lobe and did not experience cholangitis nor jaundice. Conclusion Unilateral placement of ePTFE-covered stent in the lobe with patent portal vein seems to be a safe and effective method for palliative treatment of patients with contralateral portal vein occlusion. In addition, ePTFE-covered stent placement can prevent tumor ingrowth without functional occlusion of segmental bile ducts.     

Clinical experience of expandable metallic stent placement for malignant biliary obstruction]

Expandable metallic stents of modified Gianturco design were used in nine cases of malignant biliary obstruction. Stents were placed through a percutaneous transhepatic approach without any severe complications. Initial patency was obtained seven of nine patients. Of these seven patients, recurrent jaundice was observed in three within four weeks. One patient had recurrent stenosis after four months due to ingrowth of the tumor. Although the expandable metallic stent offers several theoretical advantages over currently available stents, a disadvantage is that tumors may grow through the spaces between the legs of the wire or grow over the stent. We found that multi-modal treatment combined with radiation therapy was indispensable to maintain the patency of the stent in malignant biliary obstruction.     

国产镍钛支架治疗恶性胆道梗阻的临床分析

目的:探讨经皮肝穿胆道植入国产镍钛支架治疗恶性梗阻性黄疸的价值和临床效果。方法:在X线监视下,22例恶性梗阻性黄疸患者经皮肝穿植入国产镍钛合金自膨式裸支架24枚,恶性梗阻的原因分别为胆管细胞癌8例,胰头癌6例,肝癌3例,壶腹癌2例,肝门转移性病变3例。结果:22例患者共24枚支架全部成功植入,术后21例患者症状缓解,总胆红素明显降低。1例患者术后1天出血死亡,30天生存率为95.5%.4个月和7个月后分别有3枚支架堵塞,通过支架内支架和钢丝疏导解除。结论:国产镍钛合金自膨式裸支架性能良好,临床疗效满意。