良性胆道狭窄的介入治疗

Percutaneous treatment of benign biliary stenosis

目的探讨良性胆道狭窄的介入治疗方法。方法1998年2月-2003年12月间采用介入方法治疗11例良性胆道梗阻患者,均有腹腔镜和开腹胆道手术史,经超声、CT和MRI证实为胆道狭窄。结果11例胆道狭窄共进行了19次介入治疗,其中单纯扩张15次,9例扩张后置入了塑料内涵管并在3个月后拔除,余2例扩张后放置了金属内支架治疗,2例在形成胆管结石后进行了经皮取石术。1例胆肠瘘形成后在内涵管拔除后又长期放置了内外引流管。所有患者在采取各种介入治疗方法后胆道阻塞均得到了长期缓解。结论经皮穿刺单纯扩张和放置内涵管治疗各种医源性胆管良性狭窄是一种理想的方法,其主要优点是胆管长期开通率高,创伤小,可避免进一步的外科手术。

Objective To report our experience in treating percutaneously benign biliary strictures. Methods From Feb 2001 to Dec 2005, 11 patients （7 males and 4 females, range 28-59 years） with benign biliary diseases were referred to interventional therapy. All cases underwent laparoscopic or open cholecstectomy, 1 complicated with biliary fistula after surgery. Results Nineteen percutaneous biliary interventions were performed with good long-term results. Strictures were dilated 15 times. Nine cases were treated with implantation of 3 months of plastic endoprothesis. One fistula was treated with long-term drainage. Two with stones were removed percutaneously with Dormia baskets. Metallic stent were utilized in other 2 cases. Conclusion Percutaneous management is useful in selected benign biliary stenosis. The dilation and shorttime placement of plastic endoprothesis is an effective method for benign stentosis. Its main advantage is to avoid further surgical interventions.