经皮肝胆囊穿刺在治疗胆道梗阻中的应用  

Application of percutaneous transhepatic gallbladder drainage for the treatment of acute pancreatitis with the biliary obstruction

作　　者：虞文魁[1] 李维勤[1] 汪志明[1] 赵允召[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《医学研究生学报》2006年第9期799-802,共4页Journal of Medical Postgraduates

基　　金：江苏省社会发展基金资助项目(批准号:BS2000051)

摘　　要：目的:探讨经皮肝胆囊穿刺(PTGD)在急性胰腺炎伴胆道梗阻患者解除梗阻中的应用价值。方法:选择伴有胆道梗阻的55例急性胰腺炎患者,根据治疗方法不同分为:PTGD组(27例)和内镜治疗组(28例)。比较两组患者预后、并发症和解除胆道梗阻疗效间的差异。结果:55例患者中28例先行PTGD治疗,其中3例治疗失败后改为内镜引流;27例先行内镜引流治疗,2例失败后改PTGD治疗。30例接受PTGD治疗的患者中,27例(90.0%)置管成功;30例接受内镜治疗的患者28例(93.3%)引流成功。PTGD组和内镜治疗组的梗阻解除率分别为92.6%和92.9%,两组间比较差异无显著性意义(P>0.05),但内镜治疗组的胆红素下降明显快于PTGD组(P<0.05)。PTGD组有1例发生胆瘘,1例穿刺管脱出胆囊,但PTGD组腹胀痛和肺损伤等并发症明显低于内镜治疗组(P<0.01)。两组患者急性期并发症、胰周感染率和治愈率等差异无显著性意义(P>0.05)。结论:PTGD是一种解除胰腺炎患者胆道梗阻安全有效的方法。Objective ： To evaluate the effect of ultrasound guided percutaneous transhepatic gallbladder drainage （PTGD） for the treatment of acute pancreatitis （AP） with the biliary obstruction. Methods： Twenty eight of 55 cases of AP with biliary obstruction from 2001 to 2003 received PTGD,and 3 cases received endoscopy treatment instead after PTGD had failed; 27 cased received endoscopics treatment at first, and 2 cases who failed to apply F＇TGD. The rapidity of jaundice＇s fading away, complications of the operation and outcome of patients were measured in two groups. Results：PTGD was successfully performed in 27 patients （90%）, and endoscopics treatment in 28 patients （93.3%）. The rate of biliary obstruction＇s abatement was 92.6% in PTGD and 92.9% in endoscopics group（ P 〉 0.05 ）. Compared with the PTGD, the rapidity of jaundice＇s fadeaway was more significant swiftness in endoscopics group （P 〈 0.05）. In PTGD group, bile leakage occurred in 1 patient, and downfall of drainage occurred in 1 case. The complications of bellyache and lung injury was less in PTGD than these in endoscopics group （P 〈0.01 ）. The rate of complication in first period of AP, infection around pancreas, and prognosis of the disease were no significant difference in two groups （ P 〉 0.05 ）. Conclusion ： PTGD was a safe and effective procedure for the treatment of AP with the biliary obstruction.

关 键 词：急性胰腺炎 胆道梗阻 经皮肝胆囊穿刺 内镜 

分 类 号：R657.43[医药卫生—外科学]