介入影像医学技术在晚期肝门胆管癌姑息治疗中的应用价值

Application of of interventional imaging technology to treatment of late porta hepatis bile duct cancer

目的探讨超声引导及数字减影血管造影(DSA)下经皮经肝胆道金属支架植入术在晚期肝门胆管癌伴有梗阻性黄疸治疗中的应用价值。方法回顾性分析2011年1月—2013年1月我院普外中心60例晚期肝门胆管癌伴有恶性梗阻性黄疸及肝功能严重损害患者,先行超声引导下经皮经肝胆道穿刺引流术(PTC),再在DSA下经PTC窦道植入胆道金属支架,将外引流转变为生理性内引流,以改善肝功能。结果 60例患者术前血清总胆红素(386±95)μmol/L,术后第10天,血清总胆红素下降到(189±68)μmol/L(P<0.05),碱性磷酸酶(AKP)与γ-谷氨酰转肽酶(γ-GT)也较术前明显下降(P<0.05),出现并发症7例(11.7%)。结论超声及DSA介导经皮经肝胆道内置引流术是一种治疗晚期肝门胆管癌伴恶性梗阻性黄疸的有效方法,具有安全、简便、经济、可重复等优点。

Objective To explore the value of guided ultrasound and percutaneous transhepatic cholangio metal stent implantation under DSA in late liver bile duct carcinoma accompanied by malignant obstructive jaundice. Methods Retrospective analysis was performed on 60 patients of bile duct carcinoma with obstructive jaundice and liver function damage treated from January 2011 to January 2013. They underwent ultrasound guided PTCD（ percutaneous transhepatic cholangial drainage） and then metal stent implantation under DSA（ digital subtraction angiography） for the increase in physiological internal drainage to improve their liver function. Results Preoperative serum total bilirubin（ 386 ± 95） μmol / L was decreased down to a lower postoperative level[（ 189 ± 68）μmol / L,on the 10 th day]（ P〈0. 05）,and so were alkaline phosphatase（ AKP） and GGTP or γ-GT（ gamma-glutamyl transpeptidase）（ P〈0. 05）. Complications occurred in seven（ 11. 7%） cases. Conclusion Ultrasound and DSA mediated percutaneous built-in drainage is a kind of treatment to advanced liver bile duct carcinoma with malignant obstructive jaundice. It is an effective method,and has the advantages of safety,convenience,economy and repeatability.