经皮穿刺胆道支架置入联合胆道消融术治疗恶性阻塞性黄疸

目的研究经皮穿刺胆道支架置入联合胆道消融术治疗恶性阻塞性黄疸的方法。方法选取2010至2013年徐州市中心医院收治的6例患者,男3例,女3例,平均年龄74.3（73~82）岁;术前诊断为胰腺癌2例,壶腹部周围癌1例,胃癌术后1例,肝门部胆管癌2例,其中Bismuth分型Ⅰ型1例,Bismuth分型Ⅱ型1例,术前平均血清总胆红素267.4（127.8~412.5）μmol/L,6例均有全身瘙痒、无痛性黄疸、5例有白陶土样大便;4例胆道支架置入然后胆道消融治疗,2例先消融然后胆道支架置入,功率为10 W,时间90~120 s。结果手术后1个月黄疸明显消退,大便颜色为黄色,术前平均血清总胆红素267.4（127.8~412.5）μmol/L,手术后平均血清总胆红素66.13（37.1~82.8）μmol/L,6例平均胆道和支架通畅时间128（90~145）d,4例生存期192（123~257）d,2例仍在随访中。6例术中均出现上腹部轻度烧灼感,2例出现呕吐,对症治疗好转,射频治疗术中术后未发生出血、穿孔、胆心反射等严重并发症。结论经皮穿刺胆道支架置入联合胆道消融术治疗恶性阻塞性黄疸是一种安全、有效、操作简单的方法。

胆道腔内射频消融术在胆道梗阻性疾病中的应用研究

本文介绍了Habib^(TM)EndoHPB射频消融导管及其消融原理,射频消融导管在动物实验的研究进展,以及近年国内外采用Habib^(TM)EndoHPB进行经内镜/经皮肝穿刺胆道内射频消融治疗胆道良/恶性疾病引起胆道梗阻的应用进展,说明胆道内射频消融术是治疗胆道梗阻疾病及胆道支架植入后再发梗阻安全、可行的方法,具有较好的应用价值。

Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting

Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery. Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.