Percutaneous cystic duct stent placement for the treatment of acute cholecystitis resulting from common bile duct stent placement for malignant obstruction

Common bile duct (CBD) stent placement to relieve malignant biliary obstruction can occasionally cause cystic duct obstruction and acute cholecystitis. Cholecystostomy tube placement is often performed in patients with limited life expectancy but can have a significant impact on quality of life. To allow cholecystostomy tube removal, percutaneous metallic stent placement was performed across the cystic duct via the tube tract in such a patient. The procedure included traversal across the previously placed CBD stent. At 5-month follow-up, the patient remained symptom-free. In select patients who develop acute cholecystitis after CBD stent placement for malignant obstruction, percutaneous stent placement across the cystic duct may be considered a treatment option.     

Acute calculous cholecystitis with patent cystic duct

In the diagnosis of acute cholecystitis, the interpretation of cholescintigraphy is usually not difficult. It is conceivable, however, that with unusual location of obstructing calculi atypical images could result. Three cases were studied with cholescintigraphy and one with cholecystography in which more distal locations of obstructing calculi resulted in partial visualization of the gallbladder and erroneous interpretations were possible. Nuclear medicine radiologists should, therefore, be aware that atypical gallbladder images may be the result of unexpected location of obstructing calculi. Clues for assisting in interpretation are offered.     

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.     

全身麻醉下Y型金属气管支架治疗恶性气道狭窄

目的报道国产Y型金属气管支架在全身麻醉状态下置入的个案经验。方法 3例中央型肺癌累及气管隆突导致恶性气道狭窄的男性患者,均在全身麻醉气管插管下,进行Y型金属气管支架的置入术,着重介绍Y型气管支架释放技术以及与气管插管的配合方法。结果 3例患者均成功在全麻下进行了Y型气管支架的置入,手术过程顺利,术后患者呼吸困难症状明显改善。结论全麻下进行Y型气管支架的释放,减少了术中患者的痛苦,增加了操作的安全性,其远期疗效和相关并发症需要更多的病例观察。     

胃流出道恶性梗阻的金属支架置入治疗

目的探讨金属支架治疗胃流出道恶性梗阻的操作技术及其临床疗效。方法12例胃流出道恶性梗阻患者中,胃恶性淋巴瘤1例,胰体癌术后浸润胃肠吻合口1例,胃窦癌6例,胰头癌4例。在X线电视监视下经口置入国产镍钛合金网状裸支架。除4例体质虚弱外,余8例均接受动脉插管化疗或全身化疗。结果12例患者共放置金属支架14枚,其中,2例放置2枚支架。10例放置1次成功,2例放置2次成功。所有病例梗阻症状均明显缓解,并逐渐能进半固体软食,生活质量明显提高。随访2～18个月,2例出现支架梗阻后再次置入支架,1例胆道梗阻行胆道外引流术。未发生出血、穿孔、支架移位等严重并发症。结论金属支架是胃流出道恶性梗阻安全有效的治疗方法,可迅速缓解症状,改善患者体质,提高患者的生活质量,结合化疗有望延长患者的生存期。     

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。     

腔内近距离放疗联合及支架植入治疗恶性胆道梗阻

目的：评价经皮植入125I粒子条及支架治疗恶性胆道梗阻的安全性及疗效。方法对2009年6月至2013年6月,在上海中山医院接受介入治疗的68例恶性胆道梗阻患者的资料进行回顾性分析,其中41例在胆道梗阻段同时植入支架和125I粒子条(联合治疗组),27例仅植入支架(传统治疗组),对两组患者的生存期、至黄疸进展时间及手术相关不良事件发生率进行比较。结果所有125I粒子条和支架植入均获成功。传统支架组和联合支架组术后7、14 d血清胆红素水平组间差异有统计学意义(P<0．05);联合支架组术后未发生明显骨髓抑制;单纯支架组和联合支架组中位生存期分别为123和215 d,差异有统计学意义(P<0．05)。结论腔内近程放疗联合支架植入治疗恶性胆道梗阻安全,疗效较单纯植入支架明显。     

Treatment of nasolacrimal duct obstruction with polyurethane stent placement: long-term results

OBJECTIVE: The purpose of this study was to evaluate the long-term efficacy of polyurethane stent placement in adults with nasolacrimal duct obstruction. SUBJECTS AND METHODS: Polyurethane stents were placed under fluoroscopic guidance in 52 eyes of 49 patients (mean age, 43 years) with severe epiphora due to idiopathic nasolacrimal duct obstruction. The obstruction was complete in 44 eyes and partial in eight. Clinical success was defined as complete resolution of or great improvement in the symptoms of epiphora and the patency of the lacrimal system to irrigation. Mean follow-up was 23 months (range, 14-44 months). RESULTS: Stent placement was technically successful in 50 eyes (96%). The mean fluoroscopy screening time was 2.2 min (range, 0.2-5.8 min). Two patients were lost to follow-up. Clinical success was obtained in 33 (69%) of 48 eyes. Lacrimal symptoms developed in 23 (70%) of these 33 eyes at least once during the follow-up, but these patients responded well to topical drug treatment and lacrimal irrigation. External dacryocystorhinostomy was performed in 13 eyes after failure of the stents. At surgery, lacrimal sacs were shrunken, hyperemic, and fragile in all eyes, making it difficult to anastomose with nasal mucosa. Histologic examination showed granulation tissue and chronic inflammation of the sac epithelium. CONCLUSION: The success rate of the nasolacrimal stent decreases as follow-up lengthens. After stent treatment, lacrimal symptoms frequently develop, even if the stent remains patent, and require multiple office visits and therapy. The polyurethane stent may induce a chronic inflammatory response in the lacrimal sac, which can interfere with subsequent dacryocystorhinostomy.     

Separate支架在治疗胃十二指肠恶性梗阻中的应用

目的 探讨Separate支架置入术在姑息性治疗不能手术的胃肠道恶性梗阻的可行性和有效性。方法 34例患者采用经口置入Separate支架治疗不能手术的恶性胃十二指肠梗阻。梗阻的原因分别是胃癌11例、胰腺癌12例、转移性肿瘤3例、胆道肿瘤6例和十二指肠癌2例。透视下分别将Separate支架的外层带膜支架和内层裸支架同轴重叠释放在狭窄病变处。结果 技术成功率为97％，未发生严重并发症。33例患者胃肠道梗阻症状缓解或消失，在Separate支架置入后，患者进食能力评分平均从3．8提高到1．2。随访期间未发现支架移位和肿瘤内生性生长等并发症，l例患者由于肿瘤浸润致支架近端梗阻复发，置入第2枚支架。结论 经口途径置入Separate支架姑息性治疗不能手术的胃十二指肠恶性梗阻是可行的和有效的。     

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。     

Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report

Nineteen months after a Whipple procedure for pancreatic carcinoma, a 79-year-old woman developed recurrent tumoral strictures of the bile ducts and afferent Roux-en-Y limb with resultant jaundice, cholangitis, and liver abscess. Transhepatic abscess and biliary drainages were performed first. Afferent loop obstruction was too far from biliary anastomosis to be crossed via the transhepatic route. Percutaneous jejunostomy and stenting were performed to relieve the malignant afferent loop syndrome. After initial relief of symptoms, jaundice recurred in relation to peritoneal carcinomatosis progression and was treated with percutaneous jejunostomy drainage until patient's death. Therapeutic options of tumoral occlusion of afferent loops are reviewed.     

内支架治疗直结肠癌恶性梗阻的临床分析

目的探讨金属内支架治疗直结肠恶性狭窄和梗阻的临床意义和效果。方法50例确诊直结肠癌晚期无手术治疗指征的恶性狭窄和梗阻患者,在X线透视下,经肛门置入镍钛记忆合金网状支架,术后随访2年,观察直结肠癌晚期患者生活质量有无改善。结果50例患者,共植入镍钛记忆合金网状支架56枚（6例因再次梗阻二次植入支架）。44例支架一次置入成功,占88%（44/50）,6例经二次支架置入成功,占12%（6/50）。2例肿瘤破溃瘘道形成,置入覆膜支架成功封堵瘘口。所有患者支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内28%（14/50）,6个月以上68%（34/50）,2例已超过13个月,占4%（2/50）,现仍在随访中。结论直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性狭窄和梗阻的首选姑息性治疗手段,可以有效地提高患者生存质量。     

Budd-chiari syndrome caused by obstruction of the hepatic inferior vena cava: Immediate and 2-year treatment results of transluminal angioplasty and metallic stent placement

Purpose: To assess the usefulness of percutaneous transluminal angioplasty (PTA) and expandable metallic stent (EMS) placement for treatment of Budd-Chiari syndrome (BCS). Methods: Thirty-two patients with BCS were treated by PTA alone or by PTA and EMS placement. Among the 32 patients, a membranous obstruction was found in 24 and a segmental stenosis or occlusion in 8 patients. The follow-up period for PTA was 38<+>–<+>68 months (mean 52.2 months); for EMS it was 20<+>–<+>36 months (mean 24.3 months). Results: Twenty-one patients underwent PTA as the primary treatment. Of these, one patient died of disseminated intravascular coagulation shortly after the procedure; 20 had good to excellent initial angiographic and clinical results. Of the 20, restenosis or reocclusion developed in 10 patients (48%), all before 27 months; 8 patients (38%) became symptomatic, and 2 remained symptom-free for a total recurrent obstruction rate of 50%. The EMS group of 17 patients included 11 patients who underwent primary stenting and 6 patients with secondary stenting after recurrence following primary PTA; restenosis was demonstrated in only 2 patients (12%). Conclusions: We conclude that PTA alone produces excellent short-term results and about 50% sustained patency after 2 years in patients with BCS; therefore it should remain the procedure of first choice. Stents should be reserved for primary or secondary PTA failures.     

T-configured dual stent placement in malignant biliary hilar duct obstructions with a newly designed stent

PURPOSE: To evaluate the technical success and clinical efficacy of T-configured dual stent placement in the management of malignant biliary hilar duct obstructions with a newly designed stent. MATERIALS AND METHODS: Between January 2001 and July 2002, 57 patients with malignant biliary hilar duct obstruction were treated with percutaneous transhepatic placement of two self-expandable metallic endoprostheses in a T configuration with use of a newly designed stent. The patients ranged in age from 46 to 85 years and included 37 men and 20 women. RESULTS: Stent placement with two endoprostheses was successful in all patients. The mean survival and stent patency times were 193.6 days (range, 7-442 days) and 170.3 days (range, 7-305 days), respectively. There were no statistical differences in age, sex, or Bismuth type. CONCLUSION: T-configured dual stent placement with a newly designed stent is simple, safe, and reliable in achieving bilateral internal bile drainage in patients with malignant biliary hilar obstructions.     

经皮经肝途径肠道支架植入术治疗恶性输入袢梗阻1例

输入袢梗阻(afferent loop obstruction,ALO) 是胃肠吻合术后的罕见并发症之一[1].肿瘤的复发或转移是恶性ALO 的常见病因[1-2].现报道1 例恶性ALO 患者,行经皮经肝肠道支架植入术治疗,疗效满意.     

Intraluminal brachytherapy with metallic stenting in the palliative treatment of malignant obstruction of the bile duct

PURPOSE: To describe the outcome of intraluminal high-dose-rate (HDR) brachytherapy with metallic stenting in patients with obstructing extrahepatic cholangiocarcinoma. MATERIALS AND METHODS: Eight patients with inoperable and/or unresectable extrahepatic bile duct carcinomas were treated with intraluminal brachytherapy (ILBT) followed by self-expandable metallic stent placement. Following percutaneous transhepatic drainage, ILBT was delivered by an HDR-Ir-192 source using the Micro-Selectron afterloading device. Two treatments were planned one week apart, with each treatment consisting of a single 10 Gy fraction. Biliary patency and palliative effect were assessed by serial labs (including bilirubin/alkaline phosphatase), symptomatic improvement, and/or cholangiography. RESULTS: All eight patients tolerated the first application of ILBT well, and five of them completed two-intraluminal treatments. Six of eight had satisfactory control of jaundice until death. Pain relief was observed in four of five (80%) and pruritis in six of seven (86%) patients experiencing such symptoms. The mean and median times of stent patency were 6.9 and 5 months (range, 4-14), respectively. Gastrointestinal bleeding and/or cholangitis occurred in three patients. CONCLUSION: HDR ILBT with metallic stenting for patients with obstructive jaundice from extrahepatic bile duct carcinoma appears to be feasible and associated with acceptable toxicity. These treatments may lead to an improved quality of life in these patients.     

胆道、十二指肠联合支架植入治疗恶性梗阻的临床价值

目的 评价胆道支架及十二指肠支架置人联合治疗胆道及十二指肠恶性梗阻的临床价值.方法 对22例恶性胆道及十二指肠梗阻患者先后行胆道支架及十二指肠支架植入.20例行双支架植入,2例行胆道外引流的同时行十二指肠支架植入.结果 所有患者均成功行十二指肠支架植入,20例成功行胆道支架植入.未出现并发症及不良反应,术后胆道及消化道梗阻情况解除,术后随访6个月,支架均保持通畅.结论 胆道及十二指肠支架同时植入治疗胆道及十二指肠恶性梗阻安全有效.