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目的探讨应用金属内支架治疗复杂型肝门部胆管癌,特别是侵犯肝内胆管的肝门部胆管癌的介入治疗方法。方法肝门部胆管癌45例,其中 BismuthⅡ型12例、Ⅲa型17例、Ⅲb型10例、Ⅳ型6例。45例均先行经皮经肝胆管引流术后实施胆管内支架置入术,分别以 T、Y、X 型或其组合方式留置2或3枚内支架。结果 45例患者内支架96枚全部置入成功,治疗后胆红素[(312±249)μmol/L]与治疗前[(51±42)μmol/L]相比明显下降(t=4.21,P<0.01),支架置入后30 d 内病死率为2.2%(1/45)。平均支架开通时间181.5 d(26～473 d),平均生存时间215.3 d(26～516 d)。结论对于复杂型肝门部胆管癌,胆管内支架治疗是一种有效改善患者生存质量的方法。特别对病变侵犯肝内胆管的病例,应选择不同的穿刺路径及支架留置方法,尽可能解决更多肝段的胆管引流。
Objective To investigate the interventional treatment of complicated hilar cholangiocarcinoma using metal stent, especially in the hilar cholangiocarcinoma which invades the intrahepatic bile duct. Methods 45 cases of hilar cholangiocarcinoma, including 12 cases of Bismuth Ⅱ, Ⅲ a 17 cases, Ⅲ b 10 cases, Ⅳ 6 cases. Forty-five patients underwent percutaneous transhepatic biliary drainage after biliary stent placement, respectively, T, Y, X, or a combination of two or three stent placement. Results Ninety-six stents were successfully inserted in 45 patients. The bilirubin (312 ± 249 μmol / L) after treatment was significantly lower than that before treatment [(51 ± 42) μmol / L) P <0.01). The case fatality rate within 30 days after stent implantation was 2.2% (1/45). The average open time of stent was 181.5 days (26 ~ 473 days), and the average survival time was 215.3 days (26 ~ 516 days). Conclusion For complicated hilar cholangiocarcinoma, biliary stenting is an effective way to improve the quality of life of patients. In particular, lesions of the intrahepatic bile duct cases, should choose a different approach to the puncture and stent indwelling method, as much as possible to solve the bile duct drainage of the liver segment.