Maetani I, Ukita T, Inoue H, Igarashi Y, Hoshi H, Sakai Y
Third Dept. of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, 2-17-6 Ohashi Meguro-ku, Tokyo 153-8515, Japan.
Endoscopy. 2001 Aug;33(8):719-23. doi: 10.1055/s-2001-16222.
Percutaneous microwave coagulation for recanalizing stents occluded by tumor ingrowth has been reported. With this technique, however, the percutaneous drain diminishes the quality of life in patients with unresectable tumors and a limited prognosis. Transpapillary microwave ablation was attempted in three patients with occluded stents. After a sheath had been inserted into the proximal hepatic duct across the occluded region, a microwave electrode was introduced into the intrahepatic duct via the sheath. We used microwave therapy with an output power of 40 W, based on our previous in vitro study. Except in one patient, the stents were successfully recanalized with one or two attempts. In one patient who underwent ablation in the intrahepatic duct, a 1.8-mm electrode enabled recanalization of the stent. In another who underwent ablation in the extrahepatic duct, however, a larger electrode was required. There were no procedure-related complications. Transpapillary microwave coagulation of occluded stents appears to be an alternative to percutaneous microwave coagulation with an electrode fitting the stent size. The technique might be easier with the use of a redesigned electrode with a guide wire lumen.
经皮微波凝固术用于使因肿瘤长入而闭塞的支架再通已有报道。然而，采用这种技术时，经皮引流会降低无法切除肿瘤且预后有限的患者的生活质量。对3例支架闭塞患者尝试了经乳头微波消融术。在将鞘管经闭塞区域插入肝内胆管近端后，通过鞘管将微波电极引入肝内胆管。基于我们之前的体外研究，我们使用输出功率为40W的微波疗法。除1例患者外，通过一两次尝试成功使支架再通。1例在肝内胆管进行消融的患者，使用1.8mm电极实现了支架再通。然而，另1例在肝外胆管进行消融的患者则需要更大的电极。未出现与手术相关的并发症。经乳头微波凝固闭塞支架似乎是使用适合支架尺寸电极的经皮微波凝固术的替代方法。使用带有导丝腔的重新设计电极，该技术可能会更容易。
