肝胆胰外科杂志2024，Vol.36Issue(8)：463-467,5.DOI:10.11952/j.issn.1007-1954.2024.08.004
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
Effect of fully covered metal stent placement through percutaneous transhepatic cholangial drainage fistula in the treatment of biliary-enteric anastomotic stricture
摘要
Abstract
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.关键词
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Key words
biliary-enteric anastomotic stricture/percutaneous transhepatic cholangial drainage/fully covered metal stent/percutaneous jejunal drainage/acute cholangitis分类
医药卫生引用本文复制引用
何川琦,张诚,孔祥余,杨玉龙..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[J].肝胆胰外科杂志,2024,36(8):463-467,5.基金项目
浦东新区临床特色学科基金(PWZzk2022-17) （PWZzk2022-17）
中国中西医结合学会和黄科研基金(CCP20060003P). （CCP20060003P）
