CAJ | 학술논문

目的探讨肝管汇合处恶性梗阻经皮肝穿刺内支架置入操作难点与对策.方法对23例高位胆道恶性梗阻病人采用经皮肝穿刺胆道支架置放及内外引流术(PTBD).分别观察介入成功率,并发症发生率,血清胆红素下降情况,随访胆道支架维持通畅时间和病人生存期.结果 23例首次介入成功22例,占95.65%;21例总胆红素明显下降(下降百分比>60%),2例无效(下降百分比<10%);谷丙转氨酶(GPT)和谷草转氨酶(GOT)明显下降,平均18 d恢复正常.术后发热2例(38℃),胆道出血1例,右上腹部疼痛6例,穿刺点周围局限性腹膜炎1例,GPT升高3例,经止血抗炎护肝对症治疗后2～5 d后症状消失;引流管滑脱1例;无大出血、胆汁瘘等严重并发症.全组平均生存期8.5个月.结论肝管汇合处恶性梗阻支架置放操作难度大,导丝通过梗阻段是关键,正确掌握操作方法町显著提高手术成功率.
목적 탐토간관회합처악성경조경피간천자내지가치입조작난점여대책.방법 대23례고위담도악성경조병인채용경피간천자담도지가치방급내외인류술(PTBD).분별관찰개입성공솔,병발증발생솔,혈청담홍소하강정황,수방담도지가유지통창시간화병인생존기.결과 23례수차개입성공22례,점95.65%;21례총담홍소명현하강(하강백분비>60%),2례무효(하강백분비<10%);곡병전안매(GPT)화곡초전안매(GOT)명현하강,평균18 d회복정상.술후발열2례(38℃),담도출혈1례,우상복부동통6례,천자점주위국한성복막염1례,GPT승고3례,경지혈항염호간대증치료후2～5 d후증상소실;인류관활탈1례;무대출혈、담즙루등엄중병발증.전조평균생존기8.5개월.결론 간관회합처악성경조지가치방조작난도대,도사통과경조단시관건,정학장악조작방법정현저제고수술성공솔.
Objective To explore the difficulty and strategy of percutaneous transheptic stenting for the junction of malignant hepatic duct obstruction. Method Twenty-three patients with highly malignant biliary obstruction received percutaneous transheptic biliary drainage (PTBD) by placement of stent and/or internal-external drainage tube. All the 23 patientws were followed up to determine the successful rate of surgery, the incidence of complications, decreased serum level of bilirubin, patency time of biliary stent and survival time. Results The initial operation was sucessful in 22 cases, accounting for 95.65%. Twenty-one patients had significant decline in total bilirubin (60%) and 2 had not (10%). The levels of alanine aminotransferase (GPT) and aspartate aminotransferase (GOT) decreased markedly and returned to nomral in an average of 18 d. After operation, 2 patients had fever,1 biliary tract bleeding, 6 pain in the right upper abodminal region, 1 localized peritonitis around the puncture point, 3 GPT increase and 1 drainage tube slip. There were no serious complications such as hemorrhea and biliary fistula etc. The symptoms of all these complications disappeared in 2 to 5 days through haemostasis, anti-inflammatory therapy and liver function protection. The median survival time was 8.5 months. Conclusion Although the merging of malignant hepatic duct obstruction stenting is difficult, try to pass through the obstruction by guide wire and master the right methods of operation can significantly improve the successful rate of surgery.