良恶性胆道狭窄的内支架治疗

TREATMENT OF BENIGN AND MALIGNANT BILIARY OBSTRUCTION WITH STENT PLACEMENT

目的 :探讨胆道支架置入术对良恶性胆道狭窄的临床应用价值及国产胆道支架的置入方法。方法 :对 2 5例梗阻性黄疸患者进行了经皮肝穿胆道支架置入术 ,其中恶性 2 2例 ,良性 3例。对国产胆道支架的置入器械、方法、以及胆道双支架置入术式进行了改良。结果 :胆道支架置入后黄疸明显减轻和消退。术后 1～ 2wk血清总胆红素水平较术前平均下降了 (146± 39) μmol/L(P <0 0 1)。恶性梗阻性黄疸支架置入后存活超过 6mo者14例 (6 3 6 % ) ,12mo者 5例 (2 2 7% )。支架再阻塞发生率 12 % (3/ 2 5 )。结论 :胆道支架置入术是治疗胆道狭窄的新技术 ,疗效迅速、可靠。国产支架配合长导管鞘和小鞘管技术 ,置入简便 ,创伤小。

Objective:To investigate the inserting technique and clinical applicable value of domestic biliary stents. Methods:25 patients with biliary obstruction were treated by percutaneous transhepatic insertion of domestic biliary stents, including 22 malignant and 3 benign cases. The inserting instrument and method were improved. Results:The jaundice of all patients alleviated or disappeared obviously after stent implantation. The average difference between post-and ante-operation in the serum total bilirubin level was 146±39?μmol/L(P<0 01). The survival rates of 6 and 12 months in malignant obstruction were 63.6%(14/22) ad 22.7%(5/22). The restenosis rate was 12%(3/25). Conclusion:With a long catheter sheath and a small sheath tube, the implantation of domestic biliary stents was a safe, simple and effective method in the treatment of biliary obstruction.