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目的探讨胆道恶性梗阻时经皮经肝穿刺胆道镍钛记忆合金支架置入术及其临床疗效。方法18例恶性胆道梗阻患者,采用二步法在X线透视定位下共置入支架20枚。支架放置成功后,经长鞘管注入造影剂,及时了解支架膨胀情况及通畅性,最后放置外引流管。支架选用南京微创医学科技有限公司生产的镍钛记忆合金支架。术后观察病人黄疸变化情况,肝功能及血清淀粉酶变化,随访3~11个月。结果18例均一次性置入成功。支架置入后1周,血清总胆红素(STB)下降66.27%,丙氨酸氨基转移酶(ALT)下降57.83%,天门冬氨酸氨基转移酶(AST)下降62.21%,r-谷氨酰转肽酶(r-GT)下降44.74%,血清碱性磷酸酶(ALP)下降47.57%。早期并发症包括高淀粉酶血症、急性腹膜炎、胆道出血、胆漏等。晚期主要有支架移位或再狭窄。随访期间1例死于心、肺功能衰竭。结论经皮经肝穿刺胆道支架置入术治疗不能手术切除的恶性梗阻性黄疸,是一种姑息性治疗胆道恶性梗阻的有效方法。
Objective To investigate the clinical effect of percutaneous transhepatic bile duct nickel-titanium memory alloy stent in the treatment of malignant biliary obstruction. Methods 18 patients with malignant biliary obstruction, using two-step method in X-ray positioning of 20 scaffolds. After the stent placement is successful, the contrast agent is infused through the long sheath to keep abreast of stent expansion and patency. Finally, an external drainage tube is placed. Stent selection Nanjing Minimally Invasive Medical Technology Co., Ltd. production of nickel-titanium memory alloy stent. Postoperative observation of patients with jaundice changes, liver function and serum amylase changes, followed up for 3 to 11 months. Results 18 cases were successfully implanted one time. One week after stent implantation, serum total bilirubin (STB) decreased 66.27%, alanine aminotransferase (ALT) decreased 57.83%, aspartate aminotransferase (AST) decreased 62.21%, r- Acyltransferase (r-GT) decreased 44.74%, serum alkaline phosphatase (ALP) decreased 47.57%. Early complications include hyper amylase, acute peritonitis, biliary hemorrhage, and bile leakage. Late major stent displacement or restenosis. One patient died of heart failure and lung failure during follow-up. Conclusion Percutaneous transhepatic biliary stenting for the treatment of unresectable malignant obstructive jaundice is an effective method for palliative treatment of malignant biliary obstruction.