【摘要】：目的評價漸進(jìn)性球囊擴張聯(lián)合膽道持續(xù)引流治療膽腸吻合術(shù)后吻合口良性狹窄的安全性和可行性。方法回顧性分析2008年1月至2014年3月收治的49例膽腸吻合術(shù)后吻合口良性狹窄患者臨床及影像學(xué)資料。所有患者術(shù)前均行彩色超聲、MR和/或增強CT及內(nèi)鏡下或DSA下吻合口活檢病理證實為吻合口良性狹窄,其中23例患者采用經(jīng)皮肝穿漸進(jìn)性球囊(初始直徑8 mm;第2個月直徑10 mm;第3個月直徑12 mm)擴張聯(lián)合引流管持續(xù)引流(6個月)方式治療(研究組);26例患者采用單次經(jīng)皮肝穿球囊(直徑6或8 mm球囊)擴張聯(lián)合引流管置入(6個月)治療(對照組)。比較兩組患者術(shù)后臨床癥狀緩解情況,術(shù)后并發(fā)癥的發(fā)生率以及吻合口通暢時間。結(jié)果所有患者手術(shù)操作均順利完成,未見手術(shù)相關(guān)并發(fā)癥,如膽道出血,穿孔等發(fā)生。術(shù)后1周兩組患者的血清膽紅素下降明顯,組間比較未見明顯差異(P0.05)。3個月時兩組患者吻合口通暢率未見明顯差異,但在6、12和24個月時研究組的吻合口通暢率顯著高于對照組(P0.05)。研究組中,3例患者分別于11.2、14.3和17.6個月出現(xiàn)復(fù)發(fā)黃疸,MRI及增強CT證實吻合口狹窄復(fù)發(fā),給予再次的球囊擴張和引流管置入治療。對照組16例患者在球囊擴張術(shù)后3.1至17.1個月再次出現(xiàn)黃疸,其中1例患者死于播散性血管內(nèi)凝血,余15例患者給予再次的球囊擴張和引流管置入治療。結(jié)論漸進(jìn)性球囊擴張聯(lián)合膽道持續(xù)引流是治療膽腸吻合術(shù)后吻合口良性狹窄的安全、有效的微創(chuàng)手術(shù)。
[Abstract]:Objective to evaluate the safety and feasibility of progressive balloon dilatation combined with continuous drainage in the treatment of benign anastomotic stricture after choledochointestinal anastomosis. Methods the clinical and imaging data of 49 patients with benign anastomotic stricture after choledochointestinal anastomosis from January 2008 to March 2014 were analyzed retrospectively. All patients were diagnosed as benign anastomotic stenosis by color ultrasound, MR and / or enhanced CT and endoscopic or DSA anastomotic biopsy. among them, 23 patients were treated with progressive balloon (initial diameter 8 mm;, second month diameter 10 mm;, third month diameter 12 mm) dilatation combined with continuous drainage tube for 6 months (study group). 26 patients were treated with single transcatheter balloon (6 or 8 mm balloon in diameter) combined with drainage tube implantation (6 months) (control group). The remission of clinical symptoms, the incidence of postoperative complications and the time of anastomotic patency were compared between the two groups. Results the operation was successfully completed in all patients, and no complications such as bile duct bleeding and perforation were found. There was no significant difference in anastomotic patency rate between the two groups at 3 months, but the anastomotic patency rate in the study group was significantly higher than that in the control group at 6, 12 and 24 months after operation (P 0.05). In the study group, 3 patients had recurrent jaundice at 11.2 months, 14.3 months and 17.6 months, respectively. MRI and enhanced CT confirmed the recurrence of anastomotic stricture and were treated with balloon dilatation and drainage tube implantation. Jaundice occurred again in 16 patients in the control group from 3.1 to 17.1 months after balloon dilatation. One patient died of disseminated intravascular coagulation, and the other 15 patients were treated with balloon dilatation and drainage tube placement. Conclusion gradual balloon dilatation combined with continuous drainage of bile duct is a safe and effective minimally invasive operation for benign stricture of anastomotic after choledochointestinal anastomosis.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院介入放射科鄭州大學(xué)介入研究所河南省介入治療與臨床研究中心;
【分類號】：R656

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