金属内支架在治疗恶性胆道梗阻中的应用

The application of expandable metallic stent (EMS) in malignant biliary obstruction

目的 :探讨经皮肝穿刺胆道金属内支架置入治疗恶性胆道梗阻临床应用价值。方法 :对 2 7例恶性梗阻性黄疸患者行经皮肝穿胆道金属内支架置入术。男 18例 ,女 9例 ,其中肝癌 6例 ,胆管癌 7例 ,胰腺癌 5例 ,转移癌 9例。梗阻部位在胆总管 12例 ,肝总管肝门区 15例。结果 :经皮肝胆道内支架置入术技术成功率为 10 0 %。 2 7例共置入金属内支架31枚 ,术后 1周复查肝功能血清学指标 ,总胆红素、碱性磷酸酶和谷丙转氨酶较术前明显下降 ,P <0 .0 0 1。随访开通时间平均为 14 1天 ,半年开通率 5 5 .6 % ,并发症发生率为 2 5 .9% ,主要为胆道感染 ,胆道出血等。结论 :金属内支架置入术是治疗胆道梗阻性黄疽的安全。

Objective:To investigate the clinical value of percutaneous transhepatic expandable metallic stent (EMS) for treatment of malignant biliary obstruction.Methods:Biliary expandable metallic stents were percutaneously inserted in 27 patients (18 males and 9 females) with malignant obstructive jaudice.The biliary obstruction was located in the common bile duct in 12 cases,liver hilum in 15.Six had primary hepatocellular carcinoma,7 cholangiocarcinoma,5 pancreatic carcinoma,and the remaining 9 metastatic carcinoma from a variety of primary sites.Results:The technical success rate was 100%.Thirty one stents were placed in 27 patients, including 4 patients with 2 stents. The serum total bilirubin,alkaline phosphatase and transaminase were obviously declined as compared with before operation (P<0.001). The mean patency time was 141 days, the ratio of half year patency was 55.6% The complications occurred in 25.9%, mainly included biliary infection,biliary hemobilia.Conclusion:The percutaneous transhepatic of EMS implantation is an effective and safe palliative therapy for malignant biliaryoobstruction.