!^}N5ӍߐWO@ۀu4u$D#D#L-+&yg&i]H 1?xH}1cӟom{ۭ]5]Ӟ5ۮ|^<ۭv4]OM5}~p}_}iߍw^{ׇE۽9ME罴4Pbkky"https://www.newsipay.com/t/yishi/" target="_blank" class="keylink">医师感到棘手,其主要原因是不能达到多支梗阻多支分流的目的。因此,根据不同的梗阻类型,选择不同的穿刺途径和支架置入方式,尽可能保证最大面积的引流效果,对于治疗恶性梗阻性黄疸显得至关重要。
总之,PTCD联合胆道支架置入术能够有效多地降低患者的黄疸指数,明显地改善患者的临床症状,但是不同梗阻部位的患者,胆红素水平下降速度与下降幅度有差异。本研究病例数有限,观察时间短,还需进一步收集病例,细化分组,长期观察随访。
参考文献
[1]曹广劭,曹会存,刘健,等.阻塞性黄疸介入治疗的病发症分析[J].当代医学,2010,16(11):186-188.
[2] Berent A,Weisse C,Schattner M, et al.Initial experience with endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting for treatment of extrahepatic bile duct obstruction in dogs[J].Journal of the American Veterinary Medical Association,2015,246(4):436-446.
[3]黄祥忠,高峰,沈炜,等.经皮肝穿刺胆道引流术及胆管内支架植入术在恶性梗阻性黄疸治疗中的应用[J].介入放射学,2009,18(12):930-932.
[4] Pai M,Valek V,Tomas A,et al.Percutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction: feasibility and early results[J].Cardiovascular and Interventional Radiology,2014,37(1):235-240.
[5] Bismuth H,Castaing D,Traynor O.Resection or palliation: priority of surgery in the treatment of hilar cancer[J].World J Surg,1988,12(1):39-47.
[6]王成刚,沈杰,龚高全,等.肝癌合并梗阻性黄疸的双介入治疗临床研究[J].中国现代医生,2008,46(19):7-9.
[7] Sun Y,Yang Z,Tan H.Perioperative nutritional support and fluid therapy in patients with liver diseases[J].Hepatobiliary Surgery and Nutrition,2014,3(3):140.
[8]施海彬,李麟荪,徐泽宽,等.经皮胆道引流术治疗恶性梗阻性黄疸[J].介入放射学杂志,2001,10(5):292-295.
[9] Mizandari M,Pai M,Xi F,et al.Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results[J].Cardiovascular and Interventional Radiology,2013,36(3):814-819.
[10]谢宗贵,张希全,李凡东,等.胆道支架技术5年回顾(213例随访报告)[J].中华胆道外科杂志,2002,8(10):595-597.
[11] Kim D U,Kwon C I,Kang D H,et al.New antireflux self‐expandable metal stent for malignant lower biliary obstruction: in vitro and in vivo preliminary study[J].Digestive Endoscopy,2013,25(1):60-66.
[12]钱丽,张宝林.MRCP检查胆道梗阻病变的临床分析[J].医学影像学杂志,2013,23(4):634-635.
[13]翟仁友,戴可定,王剑锋,等.高位胆管梗阻的介入治疗和近期疗效分析[J].介入放射学杂志,2006,15(8):491-493.
[14] Fang Y,Gurusamy K S,Wang Q,et al.Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice[J].British Journal of Surgery,2013,100(12):1589-1596.
[15]王刚,钟红姗,王洪新,等.PTCD联合胆道支架置入术治疗恶性梗阻性黄疸39例临床疗效分析[J].中国普外基础与临床杂志,2013,20(12):1417-1420.
(收稿日期:2015-02-14) (本文编辑:周亚杰)