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OACSTPCD
Combination of percutaneous transhepatic cholangial drainage combined with percutaneous jejunal drainage for the treatment of intrahepatic bile duct stones after choledochal cyst resection
目的 评估经皮肝穿刺胆管引流(PTCD)联合经皮空肠穿刺引流(PJD)治疗胆总管囊肿切除术后肝内胆管结石的临床价值.方法 回顾性分析2022年1月至2023年12月同济大学附属东方医院采取PTCD联合PJD治疗的16例胆总管囊肿切除术后肝内胆管结石患者的临床资料,总结治疗体会.结果 16例患者中,诊断为肝内胆管结石6例,肝内胆管结石合并胆肠吻合口狭窄7例,肝内胆管结石合并左肝管狭窄3例;7例因梗阻性黄疸于外院行PTCD,7例未能找到确切的胆肠吻合的空肠襻,2例引流管穿刺进十二指肠.在我院的9例患者均成功实施PTCD,其中左肝管3例,右肝管6例,未发生出血、胆漏、气胸等并发症.16例患者在PTCD引导下成功实施PJD并完成瘘道扩张术,未发生出血、肠漏等并发症.经皮空肠胆道镜(PJCS)下球囊扩张解除胆肠吻合口及左肝管狭窄,经过3～6次胆道镜操作取净肝内胆管结石.5例胆肠吻合口狭窄患者及3例左肝管狭窄经PTCD瘘道置入全覆膜金属支架(FCMS),FCMS留置6～9个月无移位,经PTCD瘘道取出FCMS后,行经皮经肝胆道镜(PTCS)或PJCS检查见吻合口通畅、吻合口黏膜移行良好.随访5～16个月未发现狭窄复发病例.结论 PJD为胆总管囊肿切除术后肝内胆管结石的胆道镜治疗提供了一条便捷路径,PTCD引导不仅能增加PJD成功率,还能降低FCMS的移位率.
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.
张诚;何川琦;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
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
intrahepatic bile duct stonescholedochal cystpercutaneous jejunal drainagepercutaneous transhepatic cholangial drainagebiliary-enteric anastomotic stricturefully covered metal stent
《肝胆胰外科杂志》 2024 (008)
468-471,490 / 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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