【作者】 顾仰葵； 吴沛宏； 崔毅； 魏洪伟； 黄金华； 范卫君； 张福君； 张亮； 高飞；

【Author】 Gu Yang-kui,Wei Hong-wei,Huang Jin-hua,Fan Wei-jun,Zhang Liang,Gao Fei. Department of Imaging and Interventional Radiology,State Key Laboratory of Oncology in Southern China,Department of Medical Imaging &Interventional Radiology,Cancer Center,Sun Yat-sen University,Guangzhou 51 0060,China

【机构】 中山大学肿瘤防治中心影像介入中心； 中山大学附属第一医院消化内科； 辽河油田中心医院肿瘤科；

【摘要】 目的回顾性分析经皮经肝胆管引流及胆管支架置入术后严重并发症的介入处理方法。方法对113例恶性胆管梗阻的患者行经皮经肝引流和置入金属内支架,13例出现严重并发症采取介入或其他非外科手段成功处理并发症。分别为:4例发生引流管部分滑脱并盘曲于肝脏与腹壁之间,在CT扫描定位下或在DSA透视下用胆道穿刺针固定引流管肝内部分后拉直盘曲部分并在导丝配合下将滑脱部分推送入胆道系统;4例支架放置位置过低或下移进入十二指肠腔造成小肠梗阻,通过内镜经口腔取出支架并在内镜直视下重新放置支架;5例术中穿刺损伤血管者术后经引流管引流出大量血性液体,采取栓塞出血血管或置入带膜血管支架封堵血管瘘口进行止血。结果 4例引流管滑脱患者均成功实施了引流管复位,复位后胆汁引流通畅,腹膜刺激症状消失;4例支架术后造成小肠梗阻者,其中3例通过内镜顺利经口腔取出并在内镜直视下重新放置支架,1例取出支架后因病人拒绝再次放置支架而采取鼻胆管引流;5例术后引流出大量血性液体者,其中2例为动脉性出血,3例为门脉性出血,4例经栓塞出血血管后成功止血,1例于门脉右支主干放置带膜血管支架封堵瘘口后成功止血。结论经皮经肝胆管引流及胆管支架置入术后出现的严重并发症采取介入或其它非外科手段均能有效的处理。更多还原

【Abstract】 Objective To retrospectively analyze interventional Management of Severe Complications During Percutaneous Transhepatic Chlangiography and Percutaneous Implantation of Biliary stents.Methods Percutaneous biliary drainage and implantation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 113 patients.13 cases developing severe complications succeeded in pulling through the complicatons by interventional or non-surgical management.Drainage catheter slipping and locating between liver and abodominal wall were seen in 4 cases.Under CT scan guidance or DSA fluoroscopy,21G needle was used to puncture the drainage catheter left in biliary tract in order to fix the catheter avoiding its continuous slipping.Then curved catheter located between abodominal and liver could be pulled straight followed by being advanced into biliary tract again with the help of guide wire.Bowl obstruction due to lower implantation or slipping of stent into the duodenum were seen in 4 cases. Endoscopy was used to capture and pull out the stents through oral and new stent was expected to be implanted back also by endoscopy.Plenty of bloody drainage caused by puncture damage to blood vessel occured in 5 cases.This kind of complication was treated by embolizing the bleeding blood vessel or implanting covered stent in the site of fistula caused by puncture.Results All slipping drainage catheters were sucfcessfully advanced back into the biliary tract again.For the complication of bowl obstruction in 4 cases,stent was captured and pulled out through oral and new stent was implanted back with the help of endoscopy in 3 cases.Just 1 case accepted nasobiliary drainage because of refusal of the patient. Complication of bloody drainage was successfully overcomed by embolizing the bleeding blood vessel or implanting covered stent in the site of fistula caused by puncture.Conclusion Severe complications post percutaneous transhepatic cholangic drainage and percutaneous implantation of biliary stents can be effectively managed by interventional or nonsurgical procedure.更多还原