介入治疗T管引流术后胆道再狭窄的初步探讨

发布时间：2018-06-10 05:37

本文选题：阻塞性黄疸 + T管　；参考：《介入放射学杂志》2017年08期

【摘要】：目的评价介入治疗外科T管引流后胆道再狭窄的疗效、安全性、可行性。方法回顾性分析2014年6月—2016年3月收治的T管术后胆道再狭窄的25例患者资料,其中胆管癌6例,胆囊癌3例,胆系结石13例,肝癌2例,胃癌外科术后1例。25例中合并胰胆管合流异常4例。经原T管途径行介入治疗22例,经T管造影后再行PTCD治疗3例。所有患者中,行球囊扩张配合胆道引流者21例,行胆道金属支架植入者4例。良性狭窄患者引流管保留2~3个月后给予拔除。患者经门诊或电话随访3~24个月,通过引流管造影评价疗效。结果介入手术均顺利,无相关并发症发生,技术成功率100%。15例良性胆道狭窄患者经原T管窦道途径行球囊扩张成形术,留置胆道10.2~12 F内外引流管,拔除原T管。随访发现1例胆管癌吻合口狭窄患者术后8个月死于肺部感染。10例恶性狭窄中,3例胆道梗阻位于T管上方,均行PTCD术;其中2例肝癌侵犯胆道患者,癌栓范围较大,行内外引流管植入;黄疸消退后分别于术后1个月、2.2个月死于肝衰竭;1例胆囊癌侵犯胆道行支架植入,术后2.5个月死于肿瘤进展。7例胆道梗阻位于T管下方,经T管窦道途径植入内外引流管4例,植入金属支架3例。其中2例胆囊癌患者分别于术后3.8个月、5个月死于肿瘤进展;5例胆管癌患者中2例术后3个月出现支架再狭窄,给予PTCD处理。3例于术后3.6个月、5.2个月、9个月死于肿瘤进展、多脏器功能衰竭。结论介入治疗外科T管引流后胆道再狭窄疗效确切,安全可行,可明显改善患者生活质量。
[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.
【作者单位】：郑州大学第一附属医院放射介入科;河南医学高等专科学校基础医学部;郑州大学第一附属医院消化内科;郑州大学第一附属医院外科;
【分类号】：R657.4

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