超声联合DSA对高位恶性梗阻性黄疸行PTCD的临床应用  

Clinical Application of PTCD for High Level Malignant Obstructive Jaundice using Ultrasound in combination with DSA

作　　者：伍海翔[1] 许国辉[1] 李政文[1] 吴戈[1] 

机构地区：[1]四川省肿瘤医院,成都610041

出　　处：《肿瘤预防与治疗》2013年第3期151-154,共4页Journal of Cancer Control And Treatment

摘　　要：目的:探讨超声联合数字减影血管造影(DSA)对肝内胆管扩张不明显(2级分支直径0.3cm^0.5cm)的高位梗阻性重度黄疸患者行经皮肝穿胆道引流述(PTCD)的方法及疗效。方法:回顾分析97例肝内胆管扩张不明显的高位梗阻性重度黄疸患者PTCD的相关资料。参照术前超声预设的引流方式、进针点、穿刺及置管路径,在超声联合DSA指引下行PTCD术;据不同梗阻类型对97例患者,采用不同的引流方式。结果:97例中91例穿刺置管成功,占93.81%。术后2周,复查血清总胆红素由平均437.82 mmol/L±205.34 mmol/L下降至137.34 mmol/L±123.34 mmol/L(P<0.05);转氨酶AST由平均124.72 IU/L±72.12 IU/L下降至46.76 IU/L±18.23 IU/L(P<0.05)、ALT由平均146.82 IU/L±92.10 IU/L下降至53.46 IU/L±23.21 IU/L(P<0.05)。PTCD术中及术后无严重出血、胆汁性腹膜炎等并发症。结论:超声联合DSA对重度梗阻性黄疸肝内胆管扩张不明显的患者行PTCD术,成功率高,并发症少且轻,值得临床推广应用。Objective： To investigate the curative effect of PTCT using ultrasound combined with DSA to treat high level ma- lignant obstructive jaundice patients who had unobvious dilated intrahepatic bile ducts （ diameter of 2 grade branch ranged from 0. 3cm to 0. 5cm）. Methods： Clinical data of 97 patients with high level malignant obstructive jaundice who accepted PTCT using ultrasound combined with DSA were retrospectively analyzed. Intrahepatic bile ducts of all the patients were not dilated obviously. According to the drainage way, puncture site and route of cathetering designed by ultrasound in advance, PTCD was conducted guided by ultrasound combined with DSA. Different types of drainage were adopted depending on the types of obstruction. Results ： The catheter were inserted successfully in 91cases （91/97, 93.81% ）. The serum total bilirubin level decreased from 437. 82 mmoL/L ±205.34 mmol/L to 137.34 mmol/L± 123.34 mmol/L（P 〈0. 05）, the AST level dropped from 124. 72 IU/L±72. 12 IU/to 46. 76 IU/L ±18.23 IU/L, and the ALT decreased from 146. 82 IU/L ±92. 10 IU/L to 53.46 IU/L ＋23.21 IU/L（P 〈0.05）two weeks after operation. No seri- ous complications such as severe bleeding, choleperitonitis was observed either in operation or postoperatively. Conclusion： The appli- cation of ultrasound combined with DSA in the operation of trFCT for the high level malignant obstructive jaundice patients who had un- obvious dilated intrahepatic bile ducts is effective with high successful rate and mild complications. It is worthy of clinical application.

关 键 词：梗阻性黄疸 超声联合DSA 经皮肝穿刺胆管置管引流术 

分 类 号：R735.8[医药卫生—肿瘤] R730.41[医药卫生—临床医学]