21例内镜治疗困难的良性胆管狭窄经皮穿刺球囊扩张及留置经皮经肝胆管引流管支撑治疗的疗效观察

A clinical observation of percutaneous balloon dilation and maintenance percutaneous transhepatic cholangial catheter drainage for treatment of 21 patients with benign biliary strictures and difficult endoscopy

目的 探讨经皮穿刺球囊扩张及留置经皮经肝胆管引流（PTCD）管支撑治疗良性胆管狭窄的价值。方法 回顾性分析北京协和医院2005年6月至2011年6月的21例内镜治疗困难的良性胆管狭窄患者的临床资料。其中12例重度胆管狭窄（狭窄〉70％）患者进行了经皮穿刺球囊扩张并在狭窄部留置PTCD管支撑治疗，9例中度胆管狭窄（狭窄〈70％）患者进行了经皮穿刺单纯在狭窄部留置PTCD管支撑治疗。结果 12例球囊扩张治疗患者，留置VTCD管支撑治疗6～12个月（中位时间9个月），11例成功拔除引流管；随访6～24个月（中位时间10个月），有9例胆管保持通畅，2例发生胆管再狭窄；1例发生严重并发症，在球囊扩张治疗时胆管动脉分支破裂出血。9例中度胆管狭窄患者单纯留置PTCD管支撑治疗1～12个月（中位时间6个月），7例成功拔管；随访5～18个月（中位时间8个月），2例发生胆管再狭窄；无严重并发症发生。结论 对于不能进行内镜治疗或者内镜治疗失败的良性胆管狭窄患者，经皮穿刺球囊扩张及留置PTCD管支撑治疗是一种有效的替代治疗方法。单纯留置PTCD管支撑治疗有可能对中度良性胆管狭窄有一定的疗效。

Objective To investigate the value of percutaneous balloon dilation and percutaneous transhepatic cholangial drainage （PTCD） catheter maintenance in the treatment of benign biliary strictures. Methods The clinical data of 21 patients with benign biliary strictures at Peking Union Medical College Hospital from June 2005 to June 2011 were retrospectively studied, in which 12 patients in severe stricture （stenosis 〉 70% ） were treated with percutaneous balloon dilation and PTCD catheter placed across the stricture, while another 9 patients in median stricture（ stenosis 〈 70% ） were only treated with PTCD catheter maintenance. Results Of the 12 patients underwent balloon dilation and 6-12 months （ median： 9 months） of PTCD catheter placement, 11 patients had the catheter successfully removed. In the follow-up of 6-24 months （ median ： 10 months）, patency of bile duct was preserved in 9 of 11 patients, and recurrent stenosis was seen in 2 patients. A severe complication with biliary artery branch rupture and massive hemobilia was seen in 1 patient during balloon dilation. Of the 9 patients only treated with 1-12 months （median： 6 months） of PTCD catheter placement, 7 patients had the catheter successfully removed. In the follow-up of 5-18 months （median： 8 months） , patency of bile duct was preserved in 5 of 7 patients, and recurrent stenosis was seen in 2 patients. No severe complication occurred. Conclusions When endoscopy therapy is failed or the patient can＇t undergo endoscopy therapy, the percutaneous balloon dilation and PTCD catheter maintenance method is an effective alternative therapeutic approach in the treatment of benign biliary strictures. The moderate benign biliary stricture may be effectively treated only by the PTCD catheter maintenance method.