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目的探讨恶性胆道梗阻性黄疸经皮肝穿刺胆道支架置放术后支架再狭窄原因及介入治疗。方法20例胆道支架再狭窄患者,根据术后引流量及黄疸消退情况,于2周,1个月,2个月,3个月复查肝功、血、尿、粪及B超、CT、经引流管胆道造影,确认支架再狭窄性质、部位后,利用外置引流管途径行介入再通治疗。支架均为国产普通镍钛合金胆道支架,直径10mm,长度40~80mm。结果20例支架再狭窄中,9例为肿瘤浸润压迫所致,3例为支架上端成角致阻塞,4例为胆泥及食物残渣或陈旧性凝血块阻塞支架,2例为胆管炎性狭窄,2例为肉芽组织增生引起阻塞。全部再狭窄病例经引流管抽吸、药物灌注、冲洗、导管导丝疏通、球囊扩张、支架再植入予以复通,生存期超过6个月。结论经皮肝穿刺胆道支架植入术治疗恶性胆道梗阻,术后支架再狭窄率仍较高,应引起重视。
Objective To investigate the causes and interventional treatment of stent restenosis after percutaneous transhepatic biliary stent placement in patients with malignant biliary obstructive jaundice. Methods Twenty patients with biliary stent restenosis underwent resection of liver function, blood, urine, feces and B-ultrasound at 2 weeks, 1 month, 2 months and 3 months according to the amount of postoperative drainage and jaundice regression. Drainage tube cholangiography to confirm the nature of stent restenosis, the site, the use of external drainage tube access interventional treatment. Stents are made of ordinary nickel-titanium alloy biliary stent, diameter 10mm, length 40 ~ 80mm. Results Among the 20 cases of stent restenosis, 9 cases were caused by tumor infiltration, 3 cases were caused by angulation and obstruction at the upper end of stent, 4 cases were choledochoma and food debris or old clot blocking block, 2 cases were cholangitis stenosis , 2 cases caused by granulation tissue hyperplasia congestion. All cases of restenosis by drainage tube suction, drug infusion, irrigation, catheter guide wire dredging, balloon dilation, stent replantation to be complex, survival of more than 6 months. Conclusion Percutaneous transhepatic biliary stent implantation in the treatment of malignant biliary obstruction, postoperative stent restenosis rate is still high, should pay attention.