ObjectiveTo compare the therapeutic efficacy of biliary tract stent placing for malignant obstruction of biliary tract by percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiography (ERC). MethodsPTC approach: choosing the expansion intrahepatic bile duct which had a large angle traveling with common bile duct at the ultrasound-guided, we performed bile duct puncture and inserted the drainage pipe into it, then stent was placed with 68 cases (2 cases among the total were failure of ERC approach) after a week drainage. ERC approach: inserting drainage tube into the common bile duct by duodenal endoscopic retrogradely, the angiography showed obstruction site, the guide wire inserted through the obstruction site, then stent was placed along the guide wire with 53 cases. ResultsThe achievement ratio of stent placing by PTC was 100%(68/68), and which by ERC was 96.2%(51/53). The complications (bleeding, bile leakage) didn’t happen in two groups. 1-18 months (average 12.4 months) of follow-up, the died cases of PTC group and ERC group were 7 and 5 cases within 6 months, respectively; the survive cases of which were 17 and 9 cases after 18 months of treatment, respectively. ConclusionsThe biliary tract stent placing is a safe and effective method to the malignant obstruction of biliary tract patients who can not drainage tube be treated by operation. It can relieve biliary obstruction efficiency, and can increase live time and life quality for patients. We can choose the stent placing method by ERC for cases whose obstruction site is at the inferior of common bile duct or duodenal ampulla, and the cases whose obstruction site is at the above of hepatic porta should be chosen by PTC.
Citation:
YAN Yong,DAI Ruiwu,WANG Tao,YE Minghui,ZHANG Sheng,JIANG Zongxing,.. The Compare and Analysis of Biliary Tract Stent Placing for Malignant Obstruction of Biliary Tract by Percutaneous Transhepatic Cholangiography or Endoscopic Retrograde Cholangiography. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(11): 1184-1187. doi:
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van Delden OM, Laméris JS. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction [J]. Eur Radiol, 2008, 18(3): 448456.
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李家平, 杨建勇. 梗阻性黄疸的介入治疗 [J]. 中国实用外科杂志, 2007, 27(10): 791794..
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李佳睿, 王大伟, 兰文婧, 等. 经皮肝穿刺胆道多支架置入治疗肝门部恶性胆管梗阻19例 [J]. 中国老年学杂志, 2009, 29(15): 19481950..
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Madoff DC, Wallace MJ. Palliative treatment of unresectable bile duct cancer: which stent? which approach? [J]. Surg Oncol Clin N Am, 2002, 11(4): 923939.
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戴放, 黄信华, 陈勇, 等. 胆道支架于外科分流术姑息治疗恶性梗阻性黄疸临床疗效对比分析 [J]. 中华肝胆外科杂志, 2001, 7(2): 100102..
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许哲, 徐明林, 汤迎春. 经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸临床观察 [J]. 中国肿瘤临床与康复, 2009, 16(1): 4950..
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杜立学, 张煜, 吴武军, 等. 经皮肝胆道支架置入治疗恶性梗阻的临床研究 [J]. 现代肿瘤医学, 2009, 17(10): 19421944..
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查勇, 寸英丽, 黄云超, 等. 经皮金属支架置入治疗恶性高位胆道梗阻 [J]. 第三军医大学学报, 2009, 31(20): 2034..
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龚彪, 胡冰, 潘亚敏. 胆道恶性梗阻的内镜介入治疗 [J]. 肝胆外科杂志, 2002, 10(4): 244246..
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缪冬镠, 倪才方, 邹建伟. PTCD治疗高位恶性梗阻性黄疸的临床应用(附16例分析) [J]. 医学影像学杂志, 2006, 16(4): 359361..
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徐克, 刘瑞宝, 赵仲春, 等. 经皮经肝单侧入路行双侧胆管内引流术的临床应用 [J]. 中国医学影像技术, 2003, 19(8): 10471049..
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王忠敏, 贡桔, 伍超贤, 等. 40例恶性梗阻性黄疸双介入治疗 [J]. 中国肿瘤临床, 2004, 31(23): 13661367..
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贾广志, 张子东, 王学静, 等. 胆道双支架置入治疗肝门部胆管癌 [J]. 介入放射学杂志, 2004, 13(5): 441443..
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- 1. Soehendra N. Commonareas of inerst betweeninterventional biliary radilogy and endoscopy [J]. AJR Am J Roentgenol, 1995, 164(3): 547551.
- 2. 汪涛, 田伏洲, 蔡忠红, 等. 超声引导经皮经肝支架置入在胆道恶性梗阻中的应用 [J]. 消化外科, 2006, 5(3): 171174..
- 3. 李桂杰, 周祝谦, 董孝芳. 经皮肝穿刺胆道引流及支架置入治疗梗阻性黄疸 [J]. 中国中西医结合影像学杂志, 2004, 2(2): 131132..
- 4. 钱晓军, 翟仁友, 戴定可, 等. 老年人恶性梗阻性黄疸介入治疗回顾性分析 [J]. 中华放射学杂志, 2000, 34(5): 342344..
- 5. 郭元星, 李彦豪, 陈勇, 等. 恶性胆道梗阻支架置入术后影响患者生存期和支架开通期因素的研究(多中心研究) [J]. 中国医学影像技术, 2001, 17(11): 10271029..
- 6. 向华, 刘觉仕, 张智明, 等. 胆道支架经皮置入术治疗恶性梗阻性黄疸 [J]. 医学临床研究, 2007, 24(5): 810812..
- 7. 钱晓军, 戴定可, 翟仁友. 恶性梗阻性黄疸介入治疗的疗效分析 [J]. 中华肝胆外科杂志, 2004, 10(11): 752755..
- 8. 张正坤, 黄晓俊. 金属支架置入治疗胆道恶性梗阻性疾病的临床应用与价值 [J]. 临床消化病杂志, 2007, 19(2): 102104..
- 9. 胡冰, 周岱云, 龚彪, 等. 可膨式金属胆道支架解除恶性胆道梗阻的中长期疗效 [J]. 中华消化内镜杂志, 1998, 15(6): 327331..
- 10. 田海军, 龚值俊, 王馨月. 经皮置入术治疗恶性梗阻性黄(附25例报告) [J]. 肿瘤基础与临床, 2008, 21(5): 449450..
- 11. 孙增涛, 李继军, 刘作勤, 等. 经皮国产胆道金属内支架置入术治疗恶性梗阻性黄疸 [J]. 医学影像学杂志, 2008, 18(3): 278281..
- 12. van Delden OM, Laméris JS. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction [J]. Eur Radiol, 2008, 18(3): 448456.
- 13. 李家平, 杨建勇. 梗阻性黄疸的介入治疗 [J]. 中国实用外科杂志, 2007, 27(10): 791794..
- 14. 陈亚奇, 陈高远, 梁志鹏. 经皮胆道金属内支架置入术在治疗胆道恶性梗阻性黄疸中的应用 [J]. 实用医技杂志, 2008, 15(29): 41114112..
- 15. 翟仁友, 黄强. 恶性梗阻性黄疸介入治疗常见问题的处理 [J]. 介入放射学杂志, 2007, 16(10): 649651..
- 16. 李佳睿, 王大伟, 兰文婧, 等. 经皮肝穿刺胆道多支架置入治疗肝门部恶性胆管梗阻19例 [J]. 中国老年学杂志, 2009, 29(15): 19481950..
- 17. Madoff DC, Wallace MJ. Palliative treatment of unresectable bile duct cancer: which stent? which approach? [J]. Surg Oncol Clin N Am, 2002, 11(4): 923939.
- 18. 戴放, 黄信华, 陈勇, 等. 胆道支架于外科分流术姑息治疗恶性梗阻性黄疸临床疗效对比分析 [J]. 中华肝胆外科杂志, 2001, 7(2): 100102..
- 19. 许哲, 徐明林, 汤迎春. 经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸临床观察 [J]. 中国肿瘤临床与康复, 2009, 16(1): 4950..
- 20. 杜立学, 张煜, 吴武军, 等. 经皮肝胆道支架置入治疗恶性梗阻的临床研究 [J]. 现代肿瘤医学, 2009, 17(10): 19421944..
- 21. 查勇, 寸英丽, 黄云超, 等. 经皮金属支架置入治疗恶性高位胆道梗阻 [J]. 第三军医大学学报, 2009, 31(20): 2034..
- 22. 龚彪, 胡冰, 潘亚敏. 胆道恶性梗阻的内镜介入治疗 [J]. 肝胆外科杂志, 2002, 10(4): 244246..
- 23. 缪冬镠, 倪才方, 邹建伟. PTCD治疗高位恶性梗阻性黄疸的临床应用(附16例分析) [J]. 医学影像学杂志, 2006, 16(4): 359361..
- 24. 徐克, 刘瑞宝, 赵仲春, 等. 经皮经肝单侧入路行双侧胆管内引流术的临床应用 [J]. 中国医学影像技术, 2003, 19(8): 10471049..
- 25. 王忠敏, 贡桔, 伍超贤, 等. 40例恶性梗阻性黄疸双介入治疗 [J]. 中国肿瘤临床, 2004, 31(23): 13661367..
- 26. 贾广志, 张子东, 王学静, 等. 胆道双支架置入治疗肝门部胆管癌 [J]. 介入放射学杂志, 2004, 13(5): 441443..