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目的:探讨肝门部胆管癌胆道双支架置入的方法和术式。材料和方法:6例肝门部BismuthⅣ型胆管癌患者,采取经皮肝穿刺胆道双支架置入治疗,根据左右肝管分叉角度的不同采取不同的双支架置入术式。当分叉呈钝角时,仅通过右肝管单一穿刺通道置入双支架;当分叉呈锐角时,两个穿刺通道都在右腋中线进行,方便了操作和术后护理。结果:术后黄疸明显减轻或消退,血清胆红素水平较术前平均下降了104.37±29μmol?L(P<0.01),收到了较好的近期治疗效果。6例中有2例分别于术后4月和6月支架再阻塞。结论:双支架置入对于肝门部BismuthⅣ型胆管癌疗效可靠,根据左右肝管分叉角度采取不同的双支架置入术式方法可行。双支架置入术式要从方便操作,减少创伤,保证引流通畅来灵活掌握。
Objective: To investigate the method and operation of biliary double stent placement in hilar cholangiocarcinoma. MATERIALS AND METHODS: Six patients with hilar Bismuth type Ⅳ cholangiocarcinoma were treated with percutaneous transhepatic biliary double stent implantation. Different double stenting methods were adopted according to the angle of hepatic duct bifurcations. When the bifurcation was an obtuse angle, the double stent was implanted only through the single right hepatic duct puncture channel. When the bifurcation was acute angle, both puncture channels were performed on the right axillary line, which facilitated the operation and postoperative care. Results: Postoperative jaundice was relieved or subsided. The level of serum bilirubin was decreased by 104.37 ± 29μmol? L (P <0.01) compared with that before operation, and the treatment effect was better. Two of the six cases were re-occluded with the stent in April and June respectively. Conclusion: The double stenting is effective for the treatment of Bismuth type Ⅳ cholangiocarcinoma in the hilar. According to the left and right hepatic duct bifurcation angles, different double stenting methods are feasible. Double-stent placement from the convenience of operation, reduce trauma, to ensure smooth patency to grasp.