经皮肝穿刺胆管引流瘘道置入全覆膜金属支架治疗胆肠吻合口狭窄OACSTPCD
Effect of fully covered metal stent placement through percutaneous transhepatic cholangial drainage fistula in the treatment of biliary-enteric anastomotic stricture
目的 评价经皮肝穿刺胆管引流(PTCD)瘘道置入全覆膜金属支架(FCMS)治疗胆肠吻合口狭窄的效果.方法 回顾性分析2021年1月至2023年12月同济大学附属东方医院胆石病中心接受经PTCD瘘道置入FCMS治疗的12例胆肠吻合口狭窄患者的临床资料,总结治疗体会.结果 超声引导下PTCD成功率66.7%(8/12),超声联合X线引导下PTCD成功率100%(4/4),PTCD引导下经皮空肠穿刺引流(PJD)成功率100%(7/7).肝总管长度≥1 cm者5例,经PTCD瘘道成功置入FCMS;肝总管长度<1 cm者7例,经PTCD瘘道成功置入FCMS的同时经PJD瘘道置入塑料支架.12例患者均经FCMS管腔置入单猪尾PTCD管固定FCMS,术后未发生急性胆管炎、出血、胆漏等并发症.FCMS留置6～9个月,未发生急性胆管炎、梗阻性黄疸、FCMS移位等并发症.5例FCMS直接经PTCD瘘道取出,7例FCMS及塑料支架通过经皮空肠胆道镜(PJCS)取出.经皮经肝胆道镜(PTCS)或PJCS观察见吻合口上方局部胆管壁呈增生性改变,胆肠吻合口通畅,黏膜移行良好,未见明显瘢痕.拔除PTCD及PJD引流管后随访5～29个月,未发现狭窄复发患者.结论 经PTCD瘘道置入FCMS是治疗胆肠吻合口狭窄的一种安全、可行、有效的方法,经FCMS管腔置入单猪尾PTCD管可预防FCMS移位,经PJD瘘道置入胆管塑料支架可预防FCMS置入术后急性胆管炎.
Objective To evaluate the effect of fully covered metal stent(FCMS)placement through percutaneous transhepatic cholangial drainage(PTCD)fistula in the treatment of biliary-enteric anastomotic stricture.Methods The clinical data of 12 patients with biliary-enteric anastomotic stricture,who treated with FCMS placement through PTCD fistula in Shanghai East Hospital Affiliated to Tongji University between Jan.2021 and Dec.2023,was retrospectively analyzed.Results The success rate of ultrasound guided PTCD was 66.7%(8/12),the success rate of ultrasound combined with X-ray guided PTCD was 100%(4/4),and the success rate of PTCD guided percutaneous jejunal drainage(PJD)was 100%(7/7).Five cases with a length of the common hepatic duct≥1 cm were successfully implanted with FCMS through the PTCD fistula.Seven cases with a length of common hepatic duct<1 cm were successfully implanted with FCMS through the PTCD fistula and plastic stent through the PJD fistula.All 12 patients were fixed with a single pigtail PTCD tube through the FCMS lumen,and there was no postoperative complication such as acute cholangitis,bleeding,or bile leakage.FCMS was retained for 6-9 months without any complication such as acute cholangitis,obstructive jaundice,or FCMS displacement.Five cases of FCMS were directly removed through the PTCD fistula,and 7 cases of FCMS and plastic stent were removed through percutaneous jejunal cholangioscopy(PJCS).Percutaneous transhepatic cholangioscopy(PTCS)or PJCS examination showed proliferative changes in the local bile duct wall above the anastomotic site,with unobstructed biliary intestinal anastomosis and good mucosal migration,without obvious scars.After removing the PTCD and PJD drainage tubes,no case was found with stricture recurrence during a follow-up period of 5-29 months.Conclusion For biliary-enteric anastomotic stricture,inserting FCMS through PTCD fistula is safe,feasible,and effective.Inserting a single pigtail PTCD tube through the FCMS lumen can prevent FCMS displacement,and the placement of plastic biliary stent through PJD fistula can prevent acute cholangitis after FCMS placement.
何川琦;张诚;孔祥余;杨玉龙
同济大学附属东方医院 胆石病中心/同济大学医学院胆石病研究所,上海 200120
临床医学
胆肠吻合口狭窄经皮肝穿刺胆管引流全覆膜金属支架经皮空肠穿刺引流急性胆管炎
biliary-enteric anastomotic stricturepercutaneous transhepatic cholangial drainagefully covered metal stentpercutaneous jejunal drainageacute cholangitis
《肝胆胰外科杂志》 2024 (008)
463-467 / 5
浦东新区临床特色学科基金(PWZzk2022-17);中国中西医结合学会和黄科研基金(CCP20060003P).
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