Jeng K S, Sheen I S, Yang F S
Department of Surgery, Mackay Memorial Hospital, Mackay Junior College of Nursing, Taipei, Taiwan, Republic of China.
Surg Laparosc Endosc Percutan Tech. 2000 Oct;10(5):278-83.
For recurrent hepatolithiasis coexisting with a complicated long-segment intrahepatic biliary stricture, repeated surgeries, balloon dilation of the stricture, and external-internal stenting may still fail to solve the problem. We tried using a Gianturco-Rosch metallic Z internal stent (Wilson-Cook Medical, Inc., Bloomington, IN, USA) with the aid of percutaneous transhepatic cholangioscopy (PTCS) to treat such patients. Eight patients had a Z stent placed through a percutaneous transhepatic biliary drainage tract. Immediately after stent placement, PTCS was inserted via the percutaneous transhepatic biliary drainage route and a part of the wire skirt not firmly anchored in one of the eight patients was detected. It was successfully repositioned using PTCS. Recurrent cholangitis developed in three patients 6, 7, and 30 months, respectively, after stent placement. PTCS was undertaken again through a reestablished percutaneous transhepatic biliary drainage route and revealed sludge in their stent lumens. We cleared it by PTCS. No further cases of cholangitis occurred in later follow-up. PTCS is useful in ensuring adequate stent position, diagnosing and treating the causes of recurrent cholangitis, and prolonging the function of stents.
对于复发性肝内胆管结石合并复杂的长段肝内胆管狭窄，反复手术、狭窄部位的球囊扩张以及内外引流支架置入仍可能无法解决问题。我们尝试借助经皮经肝胆道镜检查（PTCS）使用Gianturco-Rosch金属Z形内支架（Wilson-Cook Medical公司，美国印第安纳州布卢明顿）来治疗此类患者。8例患者通过经皮经肝胆道引流通道置入了Z形支架。支架置入后立即通过经皮经肝胆道引流途径插入PTCS，发现8例患者中有1例的部分金属丝裙边固定不牢固。通过PTCS成功将其重新定位。分别在支架置入后6、7和30个月，3例患者发生复发性胆管炎。通过重新建立的经皮经肝胆道引流通道再次进行PTCS，发现其支架腔内有胆泥。我们通过PTCS将其清除。在后续随访中未再发生胆管炎病例。PTCS有助于确保支架位置合适、诊断和治疗复发性胆管炎的病因以及延长支架功能。
