经腹放置TFE胆道内支架治疗不能切除的肝门部胆管癌

PLACEMENT OF TFE STENT INSIDE BILIARY TRACT IN OPERATION TO TREAT UNRESECTALE HILAR CHOLANGIOCARCINOMA

目的 探讨手术中经腹腔放置四氟乙烯 (tetrafluoroethlene,TFE)胆道内支架对不能切除的肝门部胆管癌患者行姑息性减黄治疗的效果。方法 对 15例经手术探查证实无法切除的肝门部胆管癌患者 ,于手术中找到并切开梗阻以下的胆总管 ,向肝内胆管探查 ,开通被肿瘤阻塞的胆管 ,放置 TFE胆道内支架支撑肿瘤狭窄段胆管 ,做姑息减黄治疗。本组共放置Wilson- Cook公司的 ST- 2胆道内支架 2 0根。其中 5例于左、右肝管各放一根 ,引流全肝 ;7例仅放置 1根 ,引流半肝 (右肝管 6例 ,左肝管 1例 )。结果 所有患者术后恢复良好 ,黄疸消退顺利 ,生存质量好。术后无黄疸生存时间 3月～ 2年以上。没有发生严重并发症。结论 手术中经腹腔放置 TFE胆道内支架是对不能切除的肝门部胆管癌患者行姑息减黄治疗的有效方法。本手术操作简单 ,内引流效果确切 ,患者生存质量良好 ,值得推广应用。

Objective To evaluate the effect of the palliative treatment of unresectable hilar cholangiocarcinoma by placing the TFE stent through the obstruction.Methods 15 cases with unresectable hilar cholangiocatcinoma were treated by placing the TFE stents through the obstructed parts of biliary tract after bile duct exploration.Five cases were treated with stents placed in both hepatic ducts to drain the whole liver,and seven cases were treated with stent placed in only one hepatic duct to drain half of the liver.(6 in right hepatic duct and 1 in left hepatic duct).Results All patients recovered well after this kind of operation and the jaundice extincted smoothly.The mean survival time with out jaundice was(3 months to 2 years),no serious complication occurred.Conclusions It is an effective palliative treatment to place the TFE stent inside the biliary tract during operation for the patients with unresectable hialr cholangiocarcinoma.