發(fā)布時(shí)間：2018-06-10 05:37

  本文選題：阻塞性黃疸 + T管　； 參考：《介入放射學(xué)雜志》2017年08期

【摘要】：目的評(píng)價(jià)介入治療外科T管引流后膽道再狹窄的療效、安全性、可行性。方法回顧性分析2014年6月—2016年3月收治的T管術(shù)后膽道再狹窄的25例患者資料,其中膽管癌6例,膽囊癌3例,膽系結(jié)石13例,肝癌2例,胃癌外科術(shù)后1例。25例中合并胰膽管合流異常4例。經(jīng)原T管途徑行介入治療22例,經(jīng)T管造影后再行PTCD治療3例。所有患者中,行球囊擴(kuò)張配合膽道引流者21例,行膽道金屬支架植入者4例。良性狹窄患者引流管保留2~3個(gè)月后給予拔除。患者經(jīng)門診或電話隨訪3~24個(gè)月,通過引流管造影評(píng)價(jià)療效。結(jié)果介入手術(shù)均順利,無相關(guān)并發(fā)癥發(fā)生,技術(shù)成功率100%。15例良性膽道狹窄患者經(jīng)原T管竇道途徑行球囊擴(kuò)張成形術(shù),留置膽道10.2~12 F內(nèi)外引流管,拔除原T管。隨訪發(fā)現(xiàn)1例膽管癌吻合口狹窄患者術(shù)后8個(gè)月死于肺部感染。10例惡性狹窄中,3例膽道梗阻位于T管上方,均行PTCD術(shù);其中2例肝癌侵犯膽道患者,癌栓范圍較大,行內(nèi)外引流管植入;黃疸消退后分別于術(shù)后1個(gè)月、2.2個(gè)月死于肝衰竭;1例膽囊癌侵犯膽道行支架植入,術(shù)后2.5個(gè)月死于腫瘤進(jìn)展。7例膽道梗阻位于T管下方,經(jīng)T管竇道途徑植入內(nèi)外引流管4例,植入金屬支架3例。其中2例膽囊癌患者分別于術(shù)后3.8個(gè)月、5個(gè)月死于腫瘤進(jìn)展;5例膽管癌患者中2例術(shù)后3個(gè)月出現(xiàn)支架再狹窄,給予PTCD處理。3例于術(shù)后3.6個(gè)月、5.2個(gè)月、9個(gè)月死于腫瘤進(jìn)展、多臟器功能衰竭。結(jié)論介入治療外科T管引流后膽道再狹窄療效確切,安全可行,可明顯改善患者生活質(zhì)量。
[Abstract]:Objective to evaluate the efficacy, safety and feasibility of interventional therapy for biliary restenosis after T-tube drainage. Methods from June 2014 to March 2016, 25 patients with biliary restenosis after T tube operation were retrospectively analyzed, including 6 cases of cholangiocarcinoma, 3 cases of gallbladder carcinoma, 13 cases of cholelithiasis and 2 cases of liver cancer. Of 25 cases of gastric cancer, 4 cases were complicated with abnormal pancreaticobiliary junction. Interventional therapy was performed in 22 cases via the original T tube approach and PTCD in 3 cases after T tube angiography. Of all the patients, 21 underwent balloon dilation combined with biliary drainage, and 4 underwent biliary metal stent implantation. The drainage tube of benign stenosis was removed after 2 ~ 3 months. The patients were followed up for 3 ~ 24 months by outpatient or telephone, and the curative effect was evaluated by drainage tube angiography. Results all the interventional operations were successful, and there were no related complications. The technical success rate was 100%. 15 patients with benign biliary stricture underwent balloon dilatation via the original T-tube sinus pathway. The drainage tube was placed in the bile duct 10.2 ~ 12F and the original T-tube was removed. A patient with anastomotic stricture of cholangiocarcinoma died of pulmonary infection 8 months after operation. 3 of 10 malignant strictures with biliary obstruction located above T tube underwent PTCD, among which 2 patients with hepatocellular carcinoma invaded the biliary tract, and the range of tumor thrombus was larger. One case of gallbladder cancer invading biliary tract was implanted with stent after 1 month, 2.2 months after the jaundice disappeared, and 2.5 months after operation, 7 cases of biliary obstruction were located under T tube. Internal and external drainage tubes were implanted through T tube sinus in 4 cases and metal stent in 3 cases. Two patients with gallbladder carcinoma died of cholangiocarcinoma at 3. 8 months and 5 months after operation respectively. Among 5 patients with cholangiocarcinoma, 2 patients developed stent restenosis 3 months after operation, 3 patients were treated with PTCD at 3. 6 months, 5 months after operation, and 9 months died of tumor progression. Multiple organ failure. Conclusion interventional therapy for biliary restenosis after T-tube drainage is effective, safe and feasible, and can improve the quality of life of the patients.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院放射介入科;河南醫(yī)學(xué)高等�？茖W(xué)�；A(chǔ)醫(yī)學(xué)部;鄭州大學(xué)第一附屬醫(yī)院消化內(nèi)科;鄭州大學(xué)第一附屬醫(yī)院外科;
【分類號(hào)】：R657.4

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本文編號(hào)：2002153