经皮经肝胆管扩张并留置大口径支撑管治疗良性肝外胆道狭窄

Percutaneous intrahepatic bile duct dilation and large-bore catheter placement for benign extrahepatic biliary strictures

目的评估经皮经肝胆管扩张并留置大口径支撑管治疗良性肝外胆道狭窄的安全性和可靠性。方法回顾性分析2017年3月至2020年3月于中国医科大学附属盛京医院连续采用经皮经肝胆管扩张并留置大口径支撑管治疗的17例良性肝外胆道狭窄患者的临床资料。结果17例良性肝外胆道狭窄患者中胆肠吻合口狭窄7例,手术后肝外胆道损伤性狭窄10例(Bismuth I型6例,BismuthI型4例)。14例患者完成治疗方案,成功解除狭窄并拔除支撑管,成功率为82.3%。本组患者的治疗包括胆管扩张3~5次(中位次数为4次),逐渐更换增大支撑管尺寸并留置支撑管6~9个月(中位时间7.6个月)。3例患者未能完成治疗,其中2例患者因胆道严重狭窄,导丝未能通过狭窄段而提前终止治疗;1例患者行胆道扩张过程中因扩张器穿人肝实质引起出血而中转开腹手术。14例患者随访6~28个月(中位随访时间19个月),均无复发性狭窄出现。结论经皮经肝胆管扩张并留置大口径支撑管治疗良性肝外胆道狭窄是安全有效的。

Objective To evaluate the safety and reliability of percutaneous management of benign extrahepatic biliary strictures with biliary duct dilatation and large-bore catheter placement,Methods The clinical data of 17 patients at Shengjing Hospital from Mar 2017 to Mar 2020 was retrospectively analyzed.Results There were 7 cases of bilioenteric anastomotic strictures and 10 cases of iatrogenic biliary tract injury strictures(6 cases of Bismuth typeI and 4 cases of Bismuth type II).Fourteen of the 17 patients completed the treatment with a success rate of 82.3%.The catheter was gradually upsized to 22-24Fr.Catheters were left in place for 6-9 months(median time 7.6 months).Patients were followed up for 6-28 months(median follow-up time was 19 months),no recurrent stricture occurred.Conculsion Percutaneous management of benign extrahepatic biliary strictures with bile duct dilatation and placement of large-bore catheter is a safe and effective minimally invasive treatment method.