超声引导下经皮肝穿刺胆管引流术对恶性梗阻性黄疸的治疗价值  

Therapeutic value of ultrasound-guided percutaneous transhepatic cholangiographic drainage in malignant obstructive jaundice

作　　者：李立锋[1] 邵力飞[1] 王磊[1] 胡刚[2] 

机构地区：[1]余姚市人民医院超声科,浙江省余姚市315400 [2]余姚市人民医院肝胆外科,浙江省余姚市315400

出　　处：《世界华人消化杂志》2016年第20期3195-3198,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨超声引导下经皮肝穿刺胆管引流术对恶性梗阻性黄疸的治疗价值.方法:选取自2015-08/2016-03余姚市人民医院进行超声引导下经皮肝穿刺胆管引流术患者78例,胆管癌患者46例,胰头癌患者18例,化脓性胆管炎伴胆管结石8例,壶腹部肿瘤6例,行右肝管穿刺48例,左肝管穿刺20例,同时行左右肝管穿刺10例,观察手术疗效.结果:手术后,所有患者均一针穿刺成功,成功率100%;无发生腹腔出血和胆汁性腹膜炎等并发症,手术后,血清总胆红素、直接胆红素、碱性磷酸酶、丙氨酸转氨酶、?-古氨酰转移酶相比手术前均有显著降低,差异具有统计学意义(P<0.05).且术后45 d相比较术后10 d,各生化指标含量均有减低,差异具有统计学意义(P<0.05).结论:超声引导下经皮肝穿刺胆管引流术具有操作简便、直观、成功率高、并发症少、疗效显著等优点、是恶性梗阻性黄疸治疗的首选方案,具有更好的临床应用价值.AIM：To assess the value of ultrasound-guided percutaneous transhepatic biliary drainage（PTCD） in the treatment of malignant obstructive jaundice.METHODS：From August 2015 to March 2016,78 patients underwent ultrasound-guided PTCD at our hospital,including 46 patients with cholangiocarcinoma,18 patients with pancreatic cancer,8 patients with bile duct stones and suppurative cholangitis,and 6patients with ampullary tumor.Right hepatic duct puncture was performed in 48 cases,left hepatic duct puncture in 20 cases,and bilateral liver puncture in 10 cases.Surgical efficacy was observed.RESULTS：All patients had successful surgery,and the success rate was 100%.No bile peritonitis,abdominal bleeding or other complications occurred.Serum total bilirubin,direct bilirubin,alkaline phosphatase,alanine aminotransferase,and γ-glutamyl transferase were significantly reduced after surgery（P 0.05）.The above indices were all significantly lower on 45 d compared to 10 d after surgery（P 0.05）.CONCLUSION：Ultrasound-guided PTCD is simple and highly effective in the management of malignant obstructive jaundice,with a high success rate and few complications.

关 键 词：超声 恶性梗阻性黄疸 经皮肝穿刺胆管引流术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R730.5[医药卫生—诊断学]