透视下经皮胆管抽吸术在胆管存积物清除中的应用价值  

Clinical Significance of Percutaneous Biliary Aspiration for Removal of Biliary Sludge

作　　者：朱桥华[1] 陈勇[2] 于新发[1] 周成宇[1] 曾庆乐[2] 赵剑波[2] 李彦豪[2] 

机构地区：[1]南方医科大学附属顺德第一人民医院肿瘤介入科,528300 [2]南方医科大学附属南方医院介入治疗科,广州510515

出　　处：《临床放射学杂志》2013年第1期119-123,共5页Journal of Clinical Radiology

基　　金：广东省科技计划项目基金资助项目(编号:2009B030801210)

摘　　要：目的探讨经皮胆管抽吸术(PBA)在胆管存积物清除中的应用价值。方法 8例梗阻性黄疸患者,男6例,女2例,年龄39～68岁,平均54岁。肝移植术后2例,肝细胞癌3例,胆管细胞癌1例,外科取石术后胆管仍存残留结石2例。其中3例合并胆管感染。先行经皮肝胆管引流术,2周后总胆红素下降不到原来的1/2且经引流管行胆管造影显示胆管内仍有大量的充盈缺损,即在双导丝技术辅助下行PBA术。对比抽吸前后胆管造影表现,统计技术成功率、临床成功率和并发症,对胆管抽吸物进行病理分析。结果 8例患者均成功完成PBA术。8例患者的PBA术共进行了21次抽吸。其中2例胆管结石患者进行8次抽吸(1例3次,另1例5次),1例胆管细胞癌患者行3次抽吸,2例肝移植术后和3例肝细胞癌患者均行2次抽吸。术后再置放胆管引流管并行胆管造影示胆管内充盈缺损显著减少。术后1～2周再次复查总胆红素7例患者均下降原来的1/2以上,1个月后下降到正常范围,另1例无明显下降。3例合并胆管感染者症状明显好转。胆管抽吸物主要为胆泥、胶冻状物质、泥沙样或小结石和无结构的坏死物质。所有患者在抽吸过程中均未发现胆管出血等手术相关性并发症。结论 PBA术是一项安全、有效的清除胆管存积物的技术方法。Objective To investigate the clinical significance of percutaneous biliary aspiration（PBA） for removal of biliary sludge.Methods 8 patients with obstructive jaundice,6 males and 2 females,aged from 39 to 68y（mean 54y）,were managed with percutaneous biliary sspiration.2 cases after liver transplantation,3 cases with HCC after TACE or radiotherapy,1 case with cholangiocellular carcinoma,and 2 cases with residual stones.3 cases were accompanied with infection of biliary tract.PBA was performed when total bilirubin decreased 1/2 less than the initial level 14d after PTCD and much filling defects were observed in PTC.PTC obtained before and after PBA was compared.Technique success rate,clinical success rate and complication rate were recorded.Pathological study was performed to analyze the components of the aspirated sludge.Results PBA（21sessions in all） was performed successfully in all patients.Dramatical reduction of filling defects was shown in the PTC obtained after PBA.Total bilirubin in 7 patients decreased to 1/2 of the initial level 7d after procedures and to normal after one month.No relief of jaundice was observed.Infection was controlled well.Sludge,jelly,small stones and necrostic materials were aspirated out.Conclusion PBA is a simple,safe and effetive method for removal of biliary sludge.

关 键 词：双导丝技术 胆管 经皮抽吸 介入治疗 

分 类 号：R575.7[医药卫生—消化系统]