肝胆胰外科杂志2024，Vol.36Issue(8)：468-471,490,5.DOI:10.11952/j.issn.1007-1954.2024.08.005
经皮肝穿刺胆管引流联合经皮空肠穿刺引流治疗胆总管囊肿切除术后肝内胆管结石
Combination of percutaneous transhepatic cholangial drainage combined with percutaneous jejunal drainage for the treatment of intrahepatic bile duct stones after choledochal cyst resection
摘要
Abstract
Objective To evaluate the clinical value of percutaneous transhepatic cholangial drainage(PTCD)combined with percutaneous jejunal drainage(PJD)in the treatment of intrahepatic bile duct stones after choledochal cyst resection.Methods A retrospective analysis was conducted on the clinical data of 16 patients with intrahepatic bile duct stones after choledochal cyst resection,who underwent PTCD combined with PJD in Shanghai East Hospital between Jan.2022 and Dec.2023.The treatment experience was summarized.Results Among the 16 patients,6 cases were diagnosed with intrahepatic bile duct stones,7 cases with intrahepatic bile duct stones and biliary-enteric anastomotic strictures,and 3 cases with intrahepatic bile duct stones and left hepatic duct stenosis.PTCD was performed in external hospitals for obstructive jaundice in 7 cases,the jejunal loop of biliary-enteric anastomosis were not found in 7 cases,and the drainage tube was punctured into the duodenum in 2 cases.All the 9 patients underwent PTCD successfully in our hospital,including 3 cases in the left hepatic duct and 6 cases in the right hepatic duct.No complications such as bleeding,bile leakage,or pneumothorax occurred.PJD under the guidance of PTCD and fistula dilation surgery were successfully performed in all 16 patients,without any complications such as bleeding or intestinal leakage.Under percutaneous jejunal cholangioscopy(PJCS),balloon dilation was performed to relieve the biliary-enteric anastomosis stricture and left hepatic duct stricture,intrahepatic bile duct stones were cleaned with 3-6 times of cholangioscopy.Five cases of biliary-enteric anastomosis stricture and 3 cases of left hepatic duct stricture were treated with fully covered metal stent(FCMS)through the PTCD fistula.The FCMS was left for 6-9 months without displacement.After removing the FCMS through the PTCD fistula,smooth anastomosis and good mucosal migration were found at the anastomosis site by percutaneous transhepatic cholangioscopy(PTCS)or PJCS examination.No case was found with recurrence of stricture during a follow-up period of 5-16 months.Conclusion PJD provides a convenient pathway for the treatment of intrahepatic bile duct stones after choledochal cyst resection through choledochoscopy.PTCD guidance can not only increase the success rate of PJD,but also reduce the displacement rate of FCMS.关键词
肝内胆管结石/胆总管囊肿/经皮空肠穿刺引流/经皮肝穿刺胆管引流/胆肠吻合口狭窄/全覆膜金属支架Key words
intrahepatic bile duct stones/choledochal cyst/percutaneous jejunal drainage/percutaneous transhepatic cholangial drainage/biliary-enteric anastomotic stricture/fully covered metal stent分类
医药卫生引用本文复制引用
张诚,何川琦,孔祥余,杨玉龙..经皮肝穿刺胆管引流联合经皮空肠穿刺引流治疗胆总管囊肿切除术后肝内胆管结石[J].肝胆胰外科杂志,2024,36(8):468-471,490,5.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）
