摘要
目的探讨超声引导下经皮穿刺多支胆道引流管置入在晚期肝门胆管癌中的应用价值。方法选取2006年1月-2008年12月32例经超声、强化CT、磁共振(MRI)及经内镜逆行性胰胆管造影(ERCP)检查确诊为晚期肝门胆管癌的患者,制定合理的穿刺计划后,在超声引导下采用Seldinger技术(导丝导管交换技术)依次置入3或4支胆道外引流管,对肝内扩张胆管进行外引流,观察患者接受治疗后黄疸指数的变化及并发症发生情况,在患者生存期进行随访,对治疗效果进行综合评价。结果32例行多支胆道外引流的患者,共置入外引流管109支,其中19例同时置入3支,13例同时置入4支。所有靶胆管均完成引流管置入,成功率100%。术后4～8周黄疸完全消失28例,明显减轻4例。出现并发症2例,对症处理后均好转。患者生存期最短4个月,最长15个月。结论对于不能手术切除的晚期肝门胆管癌患者,超声引导下经皮穿刺多支胆道外引流管置入术是一种准确、安全、有效的方法,对解除恶性梗阻性黄疸有较高价值。
Objective To evaluate the feasibility and value of percutaneous transhepatic multiple biliary drainage introduced under ultrasound guidance in treatment of advanced portal cholangiocarcinoma. Methods Thirty-two patients were accurately diagnosed as advanced portal cholangio carcinoma according to preoperational examination of ultrasound,enhanced computed tomography,nuclear magnetic resonance or endoscopic retrograde cholangiopancreatography （ERCP） in the hospital from Jan. 2006 to Dec. 2008. After making a reasonable therapeutic plan,3 or 4 drainage-tubes were successfully inserted in intrahepatic bile duct in turn using Seldinger technique under ultrasound guidance. Thus,retained bile was effectively drained from intrahepatic bile ducts. The changes in jaundice index after treatment and complications were observed,follow-up was performed during the patients＇ surviving period,and therapeutic effect was evaluated comprehensively. Results Of the 32 patients drained through multiple bile drainage-tubes,19 received 3 draining tubes simultaneously,and 13 with 4 bile drainage-tubes,with a total of 109 bile drainage-tubes inserted into all the patients. Bile drainage-tubes were inserted into all target bile ducts successfully in a 100% successful rate. 4-8 weeks after operation,the jaundice disappeared completely in 28 cases and decreased significantly in 4 cases. For all the cases,complication occurred in only 2 patients,and it disappeared after symptomatic treatment. The shortest survival time was 4 months,and the longest was for 15 months after operation. Conclusions For those patients with advanced portal cholangiocarcinoma,and the tumor could not be surgically resected,percutaneous transhepatic multiple biliary drainage is correct option,which is effective and safe,and it was valuable in relieving malignant obstructive jaundice.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第11期1362-1364,共3页
Medical Journal of Chinese People's Liberation Army
关键词
超声检查
经皮经肝胆道引流术
胆管肿瘤
黄疸
阻塞性
ultrasonography
percutaneous transhepatic biliary drainage
bile duct neoplasms
jaundice
obstructive
