中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
9期
698-700
,共3页
席玮%陈骏%武贝%陈世晞
席瑋%陳駿%武貝%陳世晞
석위%진준%무패%진세희
导管消融术%黄疸,阻塞性%支架
導管消融術%黃疸,阻塞性%支架
도관소융술%황달,조새성%지가
Catheter ablation%Jaundice,obstructive%Stents
目的 初步观察双极射频导管治疗恶性胆道梗阻及胆管内支架再堵塞的可行性和安全性.方法 江苏省肿瘤医院介入科2012年3至6月收治4例晚期肿瘤导致的恶性阻塞性黄疸患者,经皮经肝路径在胆管梗阻段使用经皮穿刺式双极射频导管消融治疗,功率6~8W,使用时间60-120 s,迅速重建通道,恢复胆汁流出路径,进行手术实用性、安全性评价及并发症观察.结果 4例患者消融手术顺利,平均手术时间40 min,30 d内无死亡.无1例大出血、胆瘘、胆道感染、血(气)胸、胆汁胸、胆心综合征、肝贯通伤、胆汁性腹膜炎等并发症.胆道重建术后胆管扩张情况均明显好转,血清总胆红素及直接胆红素指标总体下降.1例胆道内支架阻塞再通患者在术后90 d胆道再次堵塞,4例平均胆道和支架通畅时间124(90~171)d.为进一步抗肿瘤治疗创造了条件.结论 经皮穿刺式双极射频导管可迅速对恶性胆道梗阻及胆管内支架再堵塞进行管道重建,提高治疗效果.
目的 初步觀察雙極射頻導管治療噁性膽道梗阻及膽管內支架再堵塞的可行性和安全性.方法 江囌省腫瘤醫院介入科2012年3至6月收治4例晚期腫瘤導緻的噁性阻塞性黃疸患者,經皮經肝路徑在膽管梗阻段使用經皮穿刺式雙極射頻導管消融治療,功率6~8W,使用時間60-120 s,迅速重建通道,恢複膽汁流齣路徑,進行手術實用性、安全性評價及併髮癥觀察.結果 4例患者消融手術順利,平均手術時間40 min,30 d內無死亡.無1例大齣血、膽瘺、膽道感染、血(氣)胸、膽汁胸、膽心綜閤徵、肝貫通傷、膽汁性腹膜炎等併髮癥.膽道重建術後膽管擴張情況均明顯好轉,血清總膽紅素及直接膽紅素指標總體下降.1例膽道內支架阻塞再通患者在術後90 d膽道再次堵塞,4例平均膽道和支架通暢時間124(90~171)d.為進一步抗腫瘤治療創造瞭條件.結論 經皮穿刺式雙極射頻導管可迅速對噁性膽道梗阻及膽管內支架再堵塞進行管道重建,提高治療效果.
목적 초보관찰쌍겁사빈도관치료악성담도경조급담관내지가재도새적가행성화안전성.방법 강소성종류의원개입과2012년3지6월수치4례만기종류도치적악성조새성황달환자,경피경간로경재담관경조단사용경피천자식쌍겁사빈도관소융치료,공솔6~8W,사용시간60-120 s,신속중건통도,회복담즙류출로경,진행수술실용성、안전성평개급병발증관찰.결과 4례환자소융수술순리,평균수술시간40 min,30 d내무사망.무1례대출혈、담루、담도감염、혈(기)흉、담즙흉、담심종합정、간관통상、담즙성복막염등병발증.담도중건술후담관확장정황균명현호전,혈청총담홍소급직접담홍소지표총체하강.1례담도내지가조새재통환자재술후90 d담도재차도새,4례평균담도화지가통창시간124(90~171)d.위진일보항종류치료창조료조건.결론 경피천자식쌍겁사빈도관가신속대악성담도경조급담관내지가재도새진행관도중건,제고치료효과.
Objective To preliminary observe the feasibility and safety of bipolar radiofrequency ablation catheter in the treatment of malignant biliary obstructive jaundice and biliary stent re-stenosis.Methods Four patients with malignant obstructive jaundice caused by terminal cancer received ablation therapy for biliary obstruction by percutaneous transhepatic bipolar radiofrequency ablation catheter.The normal tunnel of biliary was reconstructed rapidly to restore the outflow tract of bile.The procedural practicality,clinical safety and operative complications were analyzed.Results The ablation therapy was successful for 4 patients.The mean operating duration was 40 min without any 30-day mortality.No postoperative complications such as massive hemorrhage,biliary fistula,biliary infection,hemothorax,pneumothorax,cholothorax,chole-heart syndrome,liver penetrating wound and biliary peritonitis etc.occurred.Cholangiectasis improved markedly after biliary tract reconstruction with general declines of serum total bilirubin and direct bilirubin.One case with biliary stent re-stenosis was re-blocked postoperatively.The average patency time of biliary tract and stent was 124 (90-171) days in 4 cases.Conditions were created for further anti-tumor treatment.Conclusion Percutaneous transhepatic bipolar radiofrequency ablation catheter can reestablish the canal rapidly for malignant biliary obstructive jaundice and stent restenosis so as to enhance the therapeutic efficacy.