Department of Radiology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka City, Osaka 560-8565, Japan.
J Vasc Interv Radiol. 2010 Feb;21(2):252-8. doi: 10.1016/j.jvir.2009.10.010.
To evaluate the technical success and clinical effectiveness of percutaneous transcholecystic placement of self-expanding metallic stents for the treatment of malignant obstructions of the common bile duct.
Fifteen patients with malignant obstruction at the lower level of the common bile duct not amenable to surgery were retrospectively reviewed in this study. In all patients, conventional biliary drainage via transhepatic peripheral duct access or endoscopic retrograde biliary drainage (ERBD) were technically difficult or deemed so at imaging evaluation. The causes of obstruction were cholangiocarcinoma (n = 7), pancreatic carcinoma (n = 6), and metastatic lymphadenopathy from gastric carcinoma in the hepatoduodenal ligament (n = 2). Following percutaneous cholecystostomy, a 5-F catheter was inserted into the common bile duct, duodenum, or the anastomosed jejunum through the cystic duct and the malignant obstruction and metallic stents were placed. The technical success was defined as the removal of the drainage tube after the stent placement for the obstruction. The mean follow-up period was 25.4 months.
Sixteen stents were placed in 15 patients. Technical success was achieved in all patients (100%) without major complications. Minor complications included controllable pain or self-limited hemobilia in six of the 15 patients (40%). Lower bilirubin levels compared with those before the procedure were achieved in 14 of the 15 patients (93%).
Percutaneous transcholecystic placement of metallic stents is a feasible and effective method to manage malignant obstruction at the lower level of the common bile duct not amenable to surgery when conventional biliary drainage via transhepatic peripheral duct access or ERBD were technically difficult or deemed so at imaging evaluation.
评估经皮经胆囊穿刺放置自膨式金属支架治疗不可切除的胆总管下段恶性梗阻的技术成功率和临床疗效。
本研究回顾性分析了 15 例胆总管下段恶性梗阻且无法手术的患者。所有患者均经影像学评估认为经肝外周胆管入路或内镜逆行胰胆管造影（ERCP）行常规胆道引流技术上困难或不可行。梗阻的原因包括胆管癌（n=7）、胰腺癌（n=6）和胃十二指肠韧带转移性淋巴结病（n=2）。经皮胆囊造口术后，将 5-F 导管经胆囊管插入胆总管、十二指肠或吻合空肠，通过该途径置入支架以解除恶性梗阻。技术成功定义为支架置入后拔除引流管。中位随访时间为 25.4 个月。
15 例患者共置入 16 枚支架。所有患者（100%）均达到技术成功，无严重并发症。轻微并发症包括 15 例患者中的 6 例（40%）可控制的疼痛或自限性胆道出血。15 例患者中的 14 例（93%）术后胆红素水平较术前降低。
当经肝外周胆管入路或 ERCP 行常规胆道引流技术上困难或不可行时，经皮经胆囊穿刺放置金属支架是一种可行且有效的方法，可用于治疗无法手术的胆总管下段恶性梗阻。
