论文部分内容阅读
肝门部恶性肿瘤手术切除率极低，临床处理十分棘手。作者采用内镜胆管引流术治疗此类肿瘤２８８例次（肝门部胆管癌１８４例、胆囊癌２３例、肝细胞癌侵犯肝门部胆管４７例、其他转移性肿瘤３４例），其中行内镜鼻胆管引流１６２例次、塑料内置管引流８０例次、放置可膨式金属胆道支架４６例、４例患者接受同期双内置管引流。引流总有效率为６７．０％，其中效果满意者４３．１％；４０例患者术后１个月内发生胆管炎，发生率为１３．８％，３例死亡；长期随访病例的平均存活期５．３个月。我们观察到治疗的效果与Ｂｉｓｍｕｔｈ分型有密切关系，如果全肝４０％以上的胆系得到引流，黄疸有望消退；左、右两侧胆管同时引流可扩大引流范围，提高疗效；应合理选择三种内镜胆管引流方法并适时灵活转换才能获得满意的疗效。结论：对于肝门部肿瘤，内镜胆管引流术是一种安全有效的治疗手段，可作为首选的姑息性治疗。
The surgical resection rate of hepatic malignancies is extremely low, and clinical treatment is very difficult. The authors used endoscopic biliary drainage to treat 288 cases of this type of tumor (184 cases of hilar cholangiocarcinoma, 23 cases of gallbladder carcinoma, 47 cases of hepatocellular carcinoma invading hilar bile duct, and 34 cases of other metastatic tumors). There were 162 cases of nasal bile duct drainage, 80 cases of internal plastic tube drainage, 46 cases of expandable metal biliary stents, and 4 patients receiving double internal tube drainage during the same period. The total effective rate of drainage was 67.0%, of which 43.1% were satisfactory; 40 cases of cholangitis occurred within 1 month after operation, the incidence rate was 13.8%, and 3 cases died; the average survival rate of long-term follow-up cases 5.3 months. We observed that the effect of treatment is closely related to the Bismuth classification. If more than 40% of the whole liver is drained, the jaundice is expected to subside. Simultaneous drainage of left and right bile ducts can expand the drainage range and improve the therapeutic effect. Endoscopic bile duct drainage methods and timely flexible conversion can get satisfactory results. Conclusion: For hilar tumor, endoscopic bile duct drainage is a safe and effective treatment and can be used as the first palliative treatment.