摘要
肝门部恶性肿瘤手术切除率极低，临床处理十分棘手。作者采用内镜胆管引流术治疗此类肿瘤２８８例次（肝门部胆管癌１８４例、胆囊癌２３例、肝细胞癌侵犯肝门部胆管４７例、其他转移性肿瘤３４例），其中行内镜鼻胆管引流１６２例次、塑料内置管引流８０例次、放置可膨式金属胆道支架４６例、４例患者接受同期双内置管引流。引流总有效率为６７．０％，其中效果满意者４３．１％；４０例患者术后１个月内发生胆管炎，发生率为１３．８％，３例死亡；长期随访病例的平均存活期５．３个月。我们观察到治疗的效果与Ｂｉｓｍｕｔｈ分型有密切关系，如果全肝４０％以上的胆系得到引流，黄疸有望消退；左、右两侧胆管同时引流可扩大引流范围，提高疗效；应合理选择三种内镜胆管引流方法并适时灵活转换才能获得满意的疗效。结论：对于肝门部肿瘤，内镜胆管引流术是一种安全有效的治疗手段，可作为首选的姑息性治疗。
Hilar tumors are extremely difficult to manage with a considerably lower resection rate.We performed endoscopic biliary drainage for 288 patients with hilar tumors (Klatskin tumor 184,gallbladder carcinoma 23,HCC 47 and other metastases 34) in the past 3 years.162 patients underwent endoscopic nasobiliary drainage,80 plastic biliary stenting, and 46 expandable metal stent implantation.4 patients were given double stents insertion simultaneously.43.1% of patients received good drainage with the total effective rate of 67.0%,but postprocedure cholangitis took place in 13.8% of patients within one month and 3 died of cholangitis and sepsis.In the long term follow up patients without surgical treatment,the median sruvival was 5.3 months.The outcome was closely related to Bismuth types,and jaundice could be relieved if more than about 40% of the liver was drained.The double stents for the left and right intrahepatic duct in the meantime could enlarge drainage area and improve the theraputic effectiveness.To get highest benefit,the 3 endoscopic biliary drainage methods should be choosen properly and exchanged flexibly.We conclude that endoscopic biliary drainage is a safe and useful management for the hilar tumor and should be the treatment of choice for palliating jaundice in the inoperable patients.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1997年第2期73-76,共4页
Chinese Journal of Surgery
关键词
胆管肿瘤
黄疸
胰胆管造影术
引流术
Bile duct neoplasms Jaundice Cholangiopancreatography,endoscopic retrograde
