摘要
目的探讨晚期恶性阻塞性黄疸患者胆管完全阻塞的发生原因及其开通方法。资料与方法在210例阻塞性黄疸患者中，经皮穿刺胆管造影发现35例胆管呈完全型阻塞，其中胆总管阻塞25例（上段8例，中段6例，下段11例），肝总管阻塞9例，右肝管阻塞1例。35例中胆管癌27例，壶腹癌和胰头癌各4例。采用以下步骤开通完全阻塞的胆管：（1）通过导管向阻塞处注入1％利多卡因10ml，3～5min后试图通过导丝；（2）如不能通过，保留多侧孔引流管外引流，1～2天后再试图通过导丝；（3）如仍然不能通过，经引流管每天注入丝裂霉素C（MMC）2mg或5-氟脲嘧啶（5-Fu）250mg并夹管封闭2～3h，连续注射3—5天后再试图通过导丝。以上3个步骤每次只要导丝穿过阻塞段，即按支架植入方法植入胆管支架。结果35例经局部注射利多卡因后2例导丝获得通过，另33例经引流1～2天后10例导丝获得通过，余23例经局部注射化疗药3～5天后21例导丝获得通过，所有获导丝通过的病例，均成功植入支架。结论胆管完全阻塞的形成除了与肿瘤直接侵犯有关外，还与局部痉挛、炎症等因素有关，经过辅助处理绝大部分患者导丝可以获得通过并成功植入支架。
Objective To investigate the causes of complete malignant biliary obstruction and the measures to reopen. Materials and Methods Among 210 cases of obstructive jaundice underwent percutaneous transhepatic cholangiography, 35 patients were found to be complete biliary obstruction, including obstruction of common bile duct in 25 patients and obstruction of common hepatic duct in 9 patients and obstruction of right hepatic duct in 1 patient. 35 cases of complete obstruction were caused by cholangiocarcinoma in 27 patients and by carcinoma of head of pancreas in 4 patients and by carcinoma of ampulla in 4 patients. Methods to reopen the obstructive bile duct included： （1）1% lidocaine 10ml was injected through catheter and guide wire was trying to pass through obstructive bile duct 3 - 5 minutes late; （2） If it was failed, multilateral side pore drainage tube were kept to drain continuously and guide wire was trying to pass through again 1 - 2 days late; （3） If it was failed again, anticancer drugs such as mitomycine C（MMC） 2mg or fluorouracilum（5 Fu） 250mg was injected through catheter into obstructive bile duct each day and put off three way switch for 2 - 3 hour, and guide wire was trying to pass through again 3 - 5 days late. As soon guide wire was passed through obstructive bile duct, above any step as stent was placed according to method of percutaneous placement of biliary stents. Results Guide wire was passed through obstructive bile duct in 2 of 35 patients after local injection of lidocaine. Among another 33 patients, guide wire was passed through in 10 case after locale drainage for 1 - 2 days. After locale injection of anticancer drugs for 3 - 5 days, guide wire was passed through in 21 of 23 failed patients. Stents were placed successfully in all patients who guide wires were passed through. Conclusion Invasion of tumor, spasm of bile duct and local inflammation are associated with complete obstruction of bile duct. Passing through of guide wire and placement of stent can be gotten in most patients with complete obstruction of bile duct by adjuvant management.
出处
《临床放射学杂志》
CSCD
北大核心
2006年第11期1051-1054,共4页
Journal of Clinical Radiology
关键词
阻塞性黄疸
胆管肿瘤
胆管闭塞
支架
Obstructive jaundice Biliary neoplasm Biliary occlusion Stent
