渐进性球囊扩张联合胆道持续引流治疗胆肠吻合术后吻合口良性狭窄

发布时间：2019-06-19 01:41

【摘要】：目的评价渐进性球囊扩张联合胆道持续引流治疗胆肠吻合术后吻合口良性狭窄的安全性和可行性。方法回顾性分析2008年1月至2014年3月收治的49例胆肠吻合术后吻合口良性狭窄患者临床及影像学资料。所有患者术前均行彩色超声、MR和/或增强CT及内镜下或DSA下吻合口活检病理证实为吻合口良性狭窄,其中23例患者采用经皮肝穿渐进性球囊(初始直径8 mm;第2个月直径10 mm;第3个月直径12 mm)扩张联合引流管持续引流(6个月)方式治疗(研究组);26例患者采用单次经皮肝穿球囊(直径6或8 mm球囊)扩张联合引流管置入(6个月)治疗(对照组)。比较两组患者术后临床症状缓解情况,术后并发症的发生率以及吻合口通畅时间。结果所有患者手术操作均顺利完成,未见手术相关并发症,如胆道出血,穿孔等发生。术后1周两组患者的血清胆红素下降明显,组间比较未见明显差异(P0.05)。3个月时两组患者吻合口通畅率未见明显差异,但在6、12和24个月时研究组的吻合口通畅率显著高于对照组(P0.05)。研究组中,3例患者分别于11.2、14.3和17.6个月出现复发黄疸,MRI及增强CT证实吻合口狭窄复发,给予再次的球囊扩张和引流管置入治疗。对照组16例患者在球囊扩张术后3.1至17.1个月再次出现黄疸,其中1例患者死于播散性血管内凝血,余15例患者给予再次的球囊扩张和引流管置入治疗。结论渐进性球囊扩张联合胆道持续引流是治疗胆肠吻合术后吻合口良性狭窄的安全、有效的微创手术。
[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.
【作者单位】：郑州大学第一附属医院介入放射科郑州大学介入研究所河南省介入治疗与临床研究中心;
【分类号】：R656

【相似文献】