杨宁介入医学网

胆道解剖示意图...

Jaundice Pruritus Cholangitis To allow administration of chemotherapy To improve the outcome of surgical resection To deliver additional therapies Brachytherapy Photodynamic therapy...

胆管癌 胰腺癌 胆囊癌 十二指肠癌 转移癌...

通过ERCP（endoscopic retrograde cholangiopancreatography），当ERCP失败时，经皮经肝路径植入支撑架进入12指肠。支撑架进入12指肠可能引起并发症，如支撑架嵌塞（stent impaction）、穿透或穿孔相关的瘘或脓肿【1-6】。 After percutaneous access of the...

Patterns of BilateralStent Placement Y型 每个支撑架的功能是分别的，可以经过任何一个支撑架进行再干预治疗，需要双侧穿刺 T型 Only single side puncture easily accessible for reintervention...

PTBD stenting Self-expandable Covered vs. uncovered Length (4-8 cm.) diameter (8-10 mm.) Number of stents (1-3) Stent in stent?...

最大引流策略（Strategies to Maximise Drainage） 引流左侧还是右侧，还是双侧（Right or left or both?） Drain maximum liver volume with minimal catheters or stents 支撑架还是导管引流 Stent or catheter drainage 用内镜下的塑料支撑架或金属支架，...

Type I stricture 90% success Complications 15 -20% Survival mostly 3 months Type II or III strictures 20 -40% success Complications up to 55% Survival 4 -6 weeks...

Preprocedural work-up imaging 胆道扩张 Dilated bile ducts? 解剖变异 Anatomic variations? 阻塞水平/原因/阻塞范围 Level/cause/extension obstruction? 肝萎缩 Atrophy liver? 腹水 Ascites? 胆道是否扩张？ 可以通过超声或CT/MRI等影像学容易识别出来...

Learning Objectives Consider objectives of biliary drainage in malignant disease, with reference to pre surgical and palliative drainage Consider appropriate patient selection Consider how to optimize drainage in pre-surgical and palliativ...