胆管支架联合^(125)I粒子条植入治疗恶性梗阻性黄疸相关并发症临床分析

CLINICAL ANALYSIS OF POSTOPERATIVE COMPLICATION OF BILIARY STENTING COMBINED WITH ^(125)I RADIOACTIVE SEED STRIP IMPLANTATION IN TREATING MALIGNANT OBSTRUCTIVE JAUNDICE

目的探讨胆管支架联合^(125)I粒子条植入治疗恶性梗阻性黄疸术后并发症的发生情况及处理经验。方法回顾性分析2011年4月—2016年4月在我院治疗的85例恶性梗阻性黄疸病人,所有病人均接受经皮肝穿刺胆管引流术,术后3d行胆管支架及^(125)I粒子条植入。观察病人术中、术后并发症情况。结果穿刺引流、胆管支架及^(125)I粒子条植入均成功,手术成功率100%。85例病人中31例出现并发症,发生率为36.47%。其中胆管感染8例,胆管出血3例,腹膜炎2例,引流管阻塞、移位导致的引流不畅6例,胆心反射5例,胆源性胰腺炎2例,粒子条移位5例。经处理后病人均好转出院,围手术期无死亡病例。结论胆管支架联合^(125)I粒子条植入是治疗恶性梗阻性黄疸的有效方法,然而相关并发症的发生直接影响手术疗效及病人的生存质量,围手术期的合理处理及术中规范化操作对降低并发症的发生至关重要。

Objective To explore the occurrence and treatment experience for the postoperative complications of biliary stenting combined with 125I radioactive seed strip implantation in treating obstructive jaundice. Methods The clinical data of 85 patients with malignant obstructive jaundice, who were treated in our hospital from April 2011 to April 2016, were retrospectively analyzed. All the patients underwent percutaneous transhepatic cholangiography and drainage, and further received biliary stent placement and radioactive seed strip implantation after 3 days. The intraoperative and postoperative complications were observed. Results The percutaneous drainage, biliary stent placement, and radioactive seed strip implantation were successful, with 100N success rate. Thirty-one （36.47%） of the 85 patients showed complications. There were 8 cases of biliary tract infection, 3 cases of biliary tract hemorrhage, 2 cases of bile peritonitis, 6 cases of drainage tube obstruction and shifting, 5 cases of biliary-cardiae re- flex, 2 eases of biliary pancreatitis, and 5 cases of seed strip displacement. All the patients were discharged after treatment, and no deaths occurred during the perioperative period. Conclusion Biliary stenting combined with radioactive seed strip implantation is an effective method in the treatment of malignant obstructive jaundice. However, the occurrence of related complications seriously affects surgical treatment and patients＇ postoperative quality of life. The reasonable treatment during perioperative period and intraoperative standardized operation are crucial to reduce the incidence of complications.