实时超声引导下经皮经肝胆管穿刺置管引流术治疗梗阻性黄疸临床研究  

Real-time ultrasound guided percutaneous transhepatic cholangia1 drainage in treatment of patients with obstructive jaundice

作　　者：张筠 曹军英 里子彧 刘旭 ZHANG Yun;CAO Jun-ying;LI Zi-yu;LIU Xu(Department of Ultrasound,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院超声科,辽宁沈阳110016 [2]北部战区总医院消化内科,辽宁沈阳110016

出　　处：《临床军医杂志》2019年第2期111-113,共3页Clinical Journal of Medical Officers

基　　金：辽宁省自然科学基金(2015020419);军队保健专项课题(16BJZ43)

摘　　要：目的探讨实时超声引导下经皮经肝胆管穿刺置管引流术(PTCD)治疗梗阻性黄疸的临床效果。方法回顾性分析2018年1—10月于北部战区总医院超声科行超声引导下PTCD的53例梗阻性黄疸患者的临床资料。观察PTCD术后7 d患者的临床症状及血生化指标,并分析穿刺置管成功率。结果 51例患者首次成功穿刺,成功率为96. 2%(51/53);二次全部穿刺成功,二次成功率为100. 0%(2/2)。所有患者胆管引流通畅,引流量80～450 ml/d,患者精神状况好转,皮肤及巩膜黄疸明显减轻,皮肤瘙痒等症状明显缓解。7 d后复查彩超,置管的肝内胆管无明显扩张。术后7 d,患者的血清总胆红素、血清直接胆红素、血清丙氨酸氨基转氨酶、血清碱性磷酸酶等化验指标均显著下降,与穿刺前比较,差异均有统计学意义(P <0. 05)。结论超声引导下PTCD治疗梗阻性黄疸临床治疗有效率高,术后并发症发生率低,安全性好,可有效缓解梗阻性黄疸患者的临床症状,改善肝功能。Objective To investigate the value of real-time ultrasound-guided pereutaneous transhepatic cholangial drainage( PTCD)in the treatment of patients with obstructive jaundice. Methods A retrospective study was performed on 53 cases of patients with obstructive jaundice who were admitted and underwent PTCD surgery from January to October 2018. The clinical symptoms and blood biochemical values of PTCD patients 7 days after surgery were observed,and the success rate of puncture and catheterization was analyzed. Results In this study,51 patients were successfully punctured for the first time,with a success rate of 96. 2%( 51/53). The secondary puncture was successful,and the secondary success rate was 100. 0%( 2/2). The bile duct drainage was unobstructed in all the patients,and the drainage flow was 80-450 ml/day. The mental status of the patients was improved,the skin and scleral jaundice were significantly reduced,and the skin itching and other symptoms were significantly relieved. Color doppler ultrasound was performed7 days later,and there was no obvious dilation of intrahepatic bile duct. Seven days after the operation,serum total bilirubin,serum direct bilirubin,serum alanine aminotransferase,serum alkaline phosphatase and other test indexes of the patients all reduced significantly,and the differences were statistically significant compared with those before the puncture( P < 0. 05). Conclusion PTCD guided by real-time ultrasound in the treatment of obstructive jaundice has high clinical efficacy,low incidence of postoperative complications and high safety,which can effectively relieve the clinical symptoms of obstructive jaundice patients and improve liver function.

关 键 词：超声引导 经皮经肝胆管穿刺置管引流术 梗阻性黄疸 

分 类 号：R445.1[医药卫生—影像医学与核医学]