A New Method for One Stage Bilateral Internal Drainage in Klatskin Tumor with Biliary Obstruction

Klatskin tumor 合併雙側膽管阻塞使用新的雙側引流管

Klaskin tumor及其它膽管癌經常會造成膽管的狹窄及阻塞需要放置支架引流，一般常使用的塑膠支架經常會不完整引流甚至阻塞，金屬支架則價錢昂貴且不易更換，因此我們特地設計可雙邊引流塑膠支架以解決上述問題，我們將此支架放置於一名Klaskin tumor的女性病人，這病人因凝血功能異常及腹水不適合經皮穿肝引流，內視鏡引流包括內引流及經鼻膽引流經常容易被壞死組織阻塞而達不到充份的引流效果，而這病人換成新設計的引流管雙側同時引流配合不時的灌注清洗，病人的膽汁引流量從每天45cc增加到每天300-500cc，病人的黃膽指數迅速下降而整體狀況大幅改善，這引流管持續正常引流直到病人兩個月後因肝衰竭過逝，這引流管的特性不僅容易清洗，雙側引流並且容易更換，非常適合這類的病人，臨床上仍需更多病人使用以改進。

Klatskin tumors and other hilar lesions often require stent insertion for relief of biliary obstruction. Plastic stents result in incomplete drainage and are easily obstructed. Self-expandable metallic stents are too expensive and difficult to exchange. We designed a special two-tailed plastic stent for this clinical condition and circumvented the above setbacks. We placed our novel stent into a patient with obstructive jaundice secondary to Klatskin tumor, in whom we already had employed techniques such as percutaneous transhepatic cholangiography plus drainage and endoscopy biliary drainage; neither of which proved effective. Following placement of this novel stent, bile and debris drainage increased tenfold with prompt resolution of clinical symptoms and elevated serum bilirubin. Furthermore the stent remained patent until the patient expired two months later. We also designed the stent so that it would be suitable for repeat irrigation, bilateral drainage, and easy exchange. In conclusion, this novel stent merits further study for bypassing hilar lesions and relieving bile outflow obstruction.