经皮经肝胆道镜治疗胆肠吻合术后梗阻性黄疸18例分析

Therapy of obstructive jaundice after cholangio-jejunostomy in 18 cases by PTCS.

目的 探讨由于胆肠吻合口良性狭窄及结石引起梗阻性黄疸的经皮经肝胆道镜 (PTCS)治疗的方法和疗效。方法 先行经皮经肝穿刺引流 (PTCD)建立窦道、确定诊断。膜性狭窄经PTCD窦道导入气囊、X线监视下扩张。狭窄合并结石 ,先逐步扩张窦道 ,后经PTCS取石 ;膜性狭窄气囊扩张、瘢痕性狭窄置硬塑管支撑 3～ 6个月。结果 18例中 7例膜性狭窄经 2～ 3次气囊扩张解除狭窄及梗阻。 11例狭窄合并结石全部取出 ,其中 5例瘢痕性狭窄置硬塑管解除狭窄和梗阻性黄疸。全组无严重并发症。随访 8个月至 3年 ,仅 1例再次狭窄。结论 本方法创伤小、副损伤少、疗效确切。

Objective To investigate the methods and effectiveness of therapy on obstructive jaundice after cholangio jejunostomy by PTCS.Methods First,PTCD were made to set up sinus and confirm diagnosis.The membranate stenosis was expanded in ballon catheter.If stones existed together with the stenosis or cicatricial stenosis existed,first expanded sinus progressively,then took stones out using percutaneous transhepatic choledochoscopy(PTCS),put in rigid plastic tube for cicatricial stenosis by choledochoscope and X ray.Cicatricial stenosis should be supported for 3～6 months by rigid plastic tube.Results The 7 membranate stenosis in all 18 cases were expanded for 2～3 times,then stenosis and obstructive jaundice were relieved.The stones were took out in 11 stenosis with stones.6 membranate stenosis accepted expansion and 5 cicatricial stenosis accepted rigid plastic tube supporting.All stenosis and obstructive jaundice were successfully relieved.Restenosis happened in 1 case.Conclusion The method of choledochofiberoscope and X ray has less trauma and side effects.It has definite therapeutic effectiveness.