Citron S J, Martin L G
Department of Radiology, Emory University Hospital, Atlanta, GA 30322.
Radiology. 1991 Feb;178(2):339-41. doi: 10.1148/radiology.178.2.1987589.
Results of percutaneous balloon cholangioplasty of 17 patients with 28 benign biliary strictures were compared with those of published radiologic and surgical series to determine whether stricture location was related to therapeutic success and whether a patient should undergo percutaneous or surgical therapy. Treatment was considered successful if there was no anatomic evidence of recurrent stricture or need for surgery (mean follow-up, 32 months). Treatment was successful in all nine (100%) intrahepatic (zone 1) strictures, 11 of 12 (92%) extrahepatic-extrapancreatic (zone 2) strictures, one of three (33%) intrapancreatic (zone 3) strictures, and three of four (75%) bilienteric anastomotic (zone 4) strictures. Restenosis occurred in five patients; cholangioplasty was ultimately successful in two of those patients after redilation and stent placement. On the basis of these results and those of published radiologic and surgical series, the authors believe that cholangioplasty is the treatment of choice for zone 1 strictures and is as effective as surgery for zone 2 and 4 strictures. Patients with zone 2 and 4 strictures with concomitant portal hypertension or a history of multiple previous biliary surgical procedures should be considered good candidates for cholangioplasty. Zone 3 strictures may be better treated surgically than percutaneously.
将17例患有28处良性胆管狭窄患者的经皮气囊胆管成形术结果与已发表的放射学和外科手术系列结果进行比较，以确定狭窄部位是否与治疗成功相关，以及患者应接受经皮治疗还是手术治疗。如果没有复发性狭窄的解剖学证据或手术需求（平均随访32个月），则认为治疗成功。所有9例（100%）肝内（1区）狭窄、12例中的11例（92%）肝外-胰外（2区）狭窄、3例中的1例（33%）胰内（3区）狭窄以及4例中的3例（75%）胆肠吻合口（4区）狭窄治疗均成功。5例患者发生再狭窄；其中2例患者在再次扩张和置入支架后胆管成形术最终成功。基于这些结果以及已发表的放射学和外科手术系列结果，作者认为胆管成形术是1区狭窄的首选治疗方法，并且对于2区和4区狭窄与手术治疗同样有效。伴有门静脉高压或既往有多次胆道手术史的2区和4区狭窄患者应被视为胆管成形术的良好候选者。3区狭窄手术治疗可能比经皮治疗效果更好。
