胆管癌栓内镜治疗后阻塞性黄疸原因分析及处理

Analysis of the cause and treatment of the obstructive jaundice after the treatment of the cancer emboli in the bile duct with endoscope

目的 :探讨HCC合并胆管癌栓内镜治疗后阻塞性黄疸的原因及其处理。方法 :对 1999年 1月至2 0 0 3年 6月间收治的 2 3例采用内镜介入治疗的HCC合并胆管癌栓的患者进行跟踪随访 ,对其中 18例患者在内镜治疗后加重或再度出现阻塞性黄疸的原因进行回顾性分析。结果 :本组术后黄疸的发生率为 78.3%(18/ 2 3) ,原因为胆道出血 16 .7% (3/ 18)、胆管癌栓未得到有效清除 4 4 .4 % (8/ 18)、肝门部胆管恶性狭窄 2 7.8% (5 / 18)、胆管癌栓合并肝门部胆管恶性狭窄 11.1% (2 / 18) ,内置管堵塞移位 5 0 % (9/ 18)。结论 :胆管癌栓内镜治疗后阻塞性黄疸原因以内置管堵塞移位、胆管癌栓未得到有效清除和 (或 )合并肝门部胆管恶性狭窄最为常见 ,内镜治疗后早期阻塞性黄疸加重为胆道出血所至 ,及时对应处理可有效解除症状。

Objective:To study the cause and treatment of the obstructive jaundice after the treatment of HCC combined with the cancer emboli in the bile duct with endoscope.Methods:Follow-up suryey in 23 cases of HCC combined with cancer emboli in the bile duct treated with endoscope was done from 1999.1 to 2003.6. The exacerbated or reappeared reason of the obstructive jaundice after endoscopy in 18 cases of them was retrospectively analysed.Results:The incidence of the obstructive jaundice after the treatment in all the cases was 78.3%(18/23). The causes were hemobillia in 16.7%(3/18),the halfway cleaning of the cancer emboli in the bile duct of biliary tract 44.4%(8/18),the malignant constriction of the biliary tract of porta hepatis 27.8%(5/18),the cancer emboli in the bile duct with the malignant constriction of the biliary tract of porta hepatis 11.1%(2/18),the obstruction and displacement of the indwelling tube in the biliary tract 50%(9/18).Conclusion:The most common causes of the obstructive jaundice after the treatment of the cancer emboli in the bile duct with endoscope are the blockage and displacement of the indwelling tube in the biliary tract without the efficacious cleaning of the cancer emboli in the bile duct and/or the malignant constriction of the biliary tract of porta hepatis. The exacerbation of the obstructive jaundice during the earlier stage after the treatment is caused by hemobillia. To treat the origin of the obstructive jaundice in time can relieve the symptoms of the obstructive jaundice effectively.