Eickhoff A, Schilling D, Jakobs R, Weickert U, Hartmann D, Eickhoff J C, Riemann J F
Medical Department C, Gastroenterology, Hepatology and Oncology, Klinikum Ludwigshafen, Academic Hospital of the University of Mainz, Germany.
Rocz Akad Med Bialymst. 2005;50:155-60.
The occurrence of benign bile duct stenoses is mostly associated with prior biliary surgery, pancreatic diseases or sclerosing cholangitis. It remains a challenging problem for gastroenterologists and surgeons, especially in case the endoscopic approach is not possible. The exact role of percutaneous transhepatic stenting for these patients has not been clearly defined yet.
36 patients with symptomatic benign bile duct stenoses or strictures after surgery underwent percutaneous transhepatic stenting and were studied prospectively. We were particularly interested in how many patients would achieve resolution of the stricture and tolerate removal of the drainage in the long-run.
The primary success rate of percutaneous transhepatic biliary drainage (PTBD) was 92% (33/36 patients). All patients presented improvement of jaundice and cholestasis. Relief of the stricture and clinical improvement was achieved in 72% (26/36) of patients after a median stenting time of 14.5 (6-34) months. 5.5% (2/36) required further stenting due to a persistent stricture. A clinical recovery without radiological stricture regression after stenting demonstrated 22% (8/36) of patients. Long-term failures were noted in 27% (10/36) of patients after a median follow-up of 48 months.
Percutaneous transhepatic stenting of symptomatic benign biliary strictures is safe and highly effective in achieving adequate internal bile drainage. There seems to be a therapeutic benefit not only for short-term interventional treatment but also as a sufficient long-term therapeutic alternative to surgery with tolerable complication rates.
良性胆管狭窄的发生大多与既往胆道手术、胰腺疾病或硬化性胆管炎有关。对于胃肠病学家和外科医生来说，这仍然是一个具有挑战性的问题，尤其是在内镜治疗无法进行的情况下。经皮肝穿刺支架置入术对这些患者的确切作用尚未明确界定。
36例术后出现症状性良性胆管狭窄或狭窄的患者接受了经皮肝穿刺支架置入术，并进行了前瞻性研究。我们特别关注有多少患者能够解决狭窄问题并长期耐受引流管拔除。
经皮肝穿刺胆道引流（PTBD）的首次成功率为92%（33/36例患者）。所有患者的黄疸和胆汁淤积均有所改善。在中位支架置入时间为14.5（6 - 34）个月后，72%（26/36）的患者狭窄得到缓解且临床症状改善。5.5%（2/36）的患者因持续性狭窄需要进一步置入支架。22%（8/36）的患者在支架置入后临床恢复但影像学上狭窄未消退。中位随访48个月后，27%（10/36）的患者出现长期失败情况。
对有症状的良性胆管狭窄进行经皮肝穿刺支架置入术在实现充分的胆汁内引流方面是安全且高效的。它似乎不仅对短期介入治疗有益，而且作为一种长期治疗选择可替代手术，并发症发生率可耐受。
