腹腔镜胆总管支架术治疗胰腺癌胆管梗阻(附12例报告)

Treatment of bile duct obstruction in pancreatic carcinoma with laparoscopic com mon bile duct stent: report of 12 cases

目的 介绍经镜下胆总管内置支架治疗胰腺癌胆管梗阻的手术方法。方法 1999～ 2 0 0 2年采用腹腔镜胆总管探查术 (LCDE)结合斑马导丝、胆管扩张导管、塑料胆管支架和自膨式金属胆管支架施行腹腔镜胆总管支架术 (LCBDS) 12例。结果 12例转移病灶取标本中 9例病理报告胰腺癌 ,3例未证实。 12例中 9例手术获成功 ,1例因狭窄上端波及肝总管而中转开腹放置塑料支架同时T管引流 ,1例少量胆漏腹腔引流 4d后自愈 ,1例放置塑料支架同时T管引流术后 15d死于胆管感染诱发肝肾功能衰竭。结论 选择合适病例 ,采用腹腔镜胆总管支架术处理胰腺癌胆管梗阻是一种有效、安全、简便。

Objective To introduce laparoscopic common bile duct stent (LCBDS) for the treatment of the bile duct obstruction in pancreatic carcinoma. Me thods From 1999 to 2002, LCBDS was performed by using laparoscopic common bile duct ex ploration (LCDE), zebra guidewire, dilatation catheter and bile duct stent. Resu lts Pancreatic cancer cell in site of metastasis were detected in 9 out o f 12 pa tients. Nine patients had completed successful duct drainage in 12 patients. One patient with bile leak recovered after 4 days of drainage. Because of stenosis of common hepatic duct, one patient received open abdominal operation in which s tent and T tube were placed.One patient died of the functional failure of l iver and kidney on the 15th day after operation.Conclusion It is effective, safe, simple and practicable to use LCBDS for bile duct obstruction in pancreatic carc inoma.