导丝引导法在经皮经肝胆管穿刺引流术的临床应用  

Clinical application of wire-guided percutaneous transhepatic biliary drainage

作　　者：唐丽欣[1] 唐秀芬[1] 张彬彬[1] Tang Lixin;Tang Xiufen;Zhang Binbin(Department One of Gastroenterology, Digestive Hospital, Heilongjiang Provincial Hospital, Harbin 150001, China)

机构地区：[1]黑龙江省医院消化病院消化一科,哈尔滨150001

出　　处：《中华消化内镜杂志》2019年第2期103-107,共5页Chinese Journal of Digestive Endoscopy

基　　金：哈尔滨市科技局科技创新人才研究专项资金项目(2015RAXYJ061).

摘　　要：目的探究导丝引导法在经皮经肝胆管穿刺引流术(PTBD)的可行性和安全性。方法回顾性分析2011年1月至2017年12月因胆道疾病在黑龙江省医院行PTBD治疗的174例患者资料,其中85例为常规步骤操作(常规组),89例在胆管穿刺成功后不注入造影剂,先借助导丝引导穿刺针外套管进入胆管深部,抽取胆汁充分减压后再造影(导丝引导组),比较两种方法的成功率及术后PTBD相关胆管炎发生率。结果导丝引导组与常规组比较,置管成功率比较差异无统计学意义[94.4%(84/89)比97.6%(83/85),χ2=1.200,P=0.273],但PTBD相关胆管炎发生率低于后者[10.1%(9/89)比21.2%(18/85),χ2=5.270,P=0.022]。结论导丝引导法PTBD与常规方法PTBD比较,操作成功率相当,但可降低术后胆管炎发生率。ObjectiveTo evaluate the feasibility and safety of guidewire guidance method in percutaneous transhepatic biliary drainage (PTBD). MethodsA total of 174 consecutive patients with biliary diseases who underwent PTBD in Heilongjiang Provincial Hospital from January 2011 to December 2017 were enrolled in this retrospective study. There were 85 patients undergoing conventional PTBD (the conventional group), and 89 wire-guided PTBD (the wire-guided group). In the wire-guided group, the contrast media was not injected immediately after puncture, on the contrary, the needle coat was inserted deeply along the bile duct thereafter, then the bile was extracted to reduce the pressure of bile duct, at last the contrast media was infused. The drainage success rate and incidence of cholangitis related with PTBD were compared between the two groups. ResultsThe incidence of PTBD-related cholangitis of the wire-guided group was significantly lower compared with the conventional group [10.1%(9/89) VS 21.2%(18/85),χ2=5.270, P=0.022], although the drainage success rate was not significantly different between the two groups [94.4%(84/89) VS 97.6%(83/85),χ2=1.200, P=0.273]. ConclusionWire-guided PTBD may yield a similar success rate, but can reduce the incidence of cholangitis compared with conventional PTBD.

关 键 词：胆道疾病 胆管炎 经皮经肝胆管穿刺引流术 导丝引导 

分 类 号：R575.6[医药卫生—消化系统]