左右肝管受累的梗阻性黄疸支架治疗

The stent therapy of lesions involving both left and right hepatic duct with malignant obstructive jaundice

目的探讨联合应用经皮经肝穿和内镜对左右肝管均受累高位恶性梗阻性黄疸内支架治疗的临床应用价值。方法25例均为左右肝管均受累高位恶性梗阻性黄疸患者,行经皮穿刺入右侧肝管,充分胆道内外引流后,通过内镜将"Y"型支架的一支植入左肝管、肝总管(有的可能达其下的胆管),利用右侧的引流通道将"Y"型支架的另一支在左右肝管分叉穿入支架植入右肝管和肝总管。共置入支架25枚,均为自膨式裸支架。结果25例患者中,手术成功率达100%,3例胰腺癌术后3个月内死于衰竭,2例支架置入后分别于5、7个月复发黄疸,因患者体质较差,进行了单纯的外引流,2个月内死亡。11例支架植入后均在1年内死亡,但未再出现胆管梗阻。支架植入后生存期2.5～26个月(平均11.5个月)。均获得满意的减黄效果。结论联合应用内镜下和经皮经肝穿内支架治疗左右肝管均受累的高位恶性梗阻性黄疸,是一种安全可靠、疗效确切的姑息性疗法。

Objective to investigate the clinical valve of the stent placement via the combination of percutaneous transhepatic puncture and endoscope for the treatment of the lesions involving both left and right hepatic duct with malignant hilar biliary obstructive jaundice. Methods 25 patients with the lesions involving both left and right hepatic duct with malignant hilar biliary obstructive jaundice were treated by both intemal and external drainage of biliary duct through percutaneous right hepatic duct puncture. With the help of endoscope, insert one of ＂Y＂ shape stents into the left hepatic duct and common hepatic duct （some may reach below it）, then through right drainage eharmel make another one of ＂Y＂ shape stents penetrate into the former stent in the junction of left and right hepatic duct, and place it into the right hepatic duct and common hepatic duct. In current study, 25 self-expandible bare stents were placed. Results The success rate of operation was 100% in all 25 patients, in which 3 cases with pancreatic cancer died of failure 3 months later; 2 cases with recurred jaundice in 5 and 7 months respectively were performed simple drainage, however, they died 2 months later. The survival period was 2.5 - 26 months （mean 11.5 months）, and the therapeutic results were satisfactory. Concolusion The combined application of percutaneous transhepatic puncture and endoscope is a relatively effective palliative therapy for the lesions involving both left and right hepatic duct with malignant hilar biliary obstructive jaundice.