【作者】 陈晓明； 陆骊工； 李勇； 胡宝山； 罗鹏飞；

【Author】 Chen Xiao-Ming Lu Li-Gong Li Yong et al. Department of interventional radiology, Guangdong Provincial People Hospital, Guangzhou 510080, China

【机构】 广东省人民医院肿瘤中心介入治疗科；

【摘要】 目的: 探讨晚期恶性阻塞性黄疸患者胆道完全阻塞的发生原因及其开通方法。方法:在210例阻塞性黄疸患者中,经皮穿刺胆道造影发现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,1-2d 后再试图通过导丝,(3)如失败,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3～5d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道支架。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1～2d后10例导丝获得通过,余23例经局部注射化疗药3-5d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病人导丝可以获得通过并成功植入支架。更多还原

【Abstract】 Objective: To investigate the causes of formation of complete biliary obstruction due to malignancy and the measures to open. 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 one patient. 35 cases of complete obstruction were caused separately 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 open the obstructive bile duct included: 1% lidocaine 10ml was injected through catheter and guide wire was trying to pass through ob- structi ve bile duct 3-5 minutes late, 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, If it was failed again, anti-cancer 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 locale injection of lidocaine. Among another 33 patients, guide wire was got to pass through in 10 case after locale drainage for 1-2 days. After locale injection of anti-cancer drugs for 3-5 days, guide wire was got to pass through in 21 of 23 failed patients. Stents were placed successfully in all patients who guide wires were passed through. Conclusion: Invasion of tumor and spasm of bile duct and locale inflammation were associated with formation of complete obstruction of bile duct Passing through of guide wire and placement of stent can be got in most patients with complete obstruction of bile duct by adjuvant management更多还原