联合套管针法和Seldinger技术在超声引导下PTCD治疗阻塞性黄疸的临床价值  

Clinical Value of Combined Trocar and Seldinger Technique in The Treatment of Obstructive Jaundice with Ultrasound-Guided PTCD

作　　者：卢来顺[1] 马锐[1] 吴映云[1] 王良玉[1] Lu Laishun;Ma Rui;Wu Yingyun;Wang Liangyu(Department of Ultrasound Diagnosis,Shantou Central Hospital,Guangdong 515031)

机构地区：[1]汕头市中心医院超声诊断科,广东515031

出　　处：《现代医用影像学》2019年第2期244-246,249,共4页Modern Medical Imageology

摘　　要：目的:探讨联合运用套管针法和Seldinger技术在超声引导PTCD治疗阻塞性黄疸的临床价值。方法:回顾性分析汕头市中心医院2016年6月～2018年5月收治的阻塞性黄疸患者54例,采用联合套管针法和Seldinger技术在超声引导下PTCD治疗的临床资料,总结靶向胆管内径、进肝实质深度、手术时间、置管总数、术后24 h胆汁引流量和并发症,并对比分析患者手术前后血清AST、ALT、TB、DB的差异。结果:54例患者穿刺放置PTC管55根,术前靶向胆管内径2.7～12.0mm(5.8±2.2),手术时穿刺针进入肝实质深度15～47mm(31.4±8.0),手术时间14～40min(23.7±5.8),24小时胆汁引流量180～705ml(399.6±124.7)。术后复查AST52.3±32.2U/L,ALT 49.8±29.7U/L,TB143.8±110.2μmol/L,DB 82.4±64.5μmol/L。术后AST、ALT、TB、DB与术前对比均明显下降,差异有显著统计学意义(P<0.01)。讨论:联合套管针法和Seldinger技术在超声引导下PTCD治疗阻塞性黄疸手术成功率高、并发症少,能有效改善患者黄疸症状、恢复肝功能,其导管导入加不锈钢硬套管增加其硬度提高进管的方向可控性特点,对靶向胆管位置深或内径小的阻塞性黄疸患者的治疗尤其适合。Objective:To explore the clinical value of combined use of trocar and Seidinger technique in the treatment of obstructive jaundice with ultrasound-guided PTCD.Methods:A retrospective analysis of 54 patients with obstructive jaundice admitted to Shantou Central Hospital from June 2016 to May 2018.The clinical data of ultrasound-guided PTCD treatment with combined trocar and Seldinger technique were used to summarize the target bile duct diameter.The depth of liver parenchyma,the operation times,the total number of catheters,the 24-hour postoperative bile drainage and complications,and the differences in serum AST,ALT,TB and DB before and after surgery were compared.Results:54 patients underwent puncture placement of 55 PTC tubes.The intraoperative target bile duct diameter was 2.7-12.0mm (5.8±2.2).The needle penetration into the liver parenchyma was 15 -47mm (31.4 ± 8.0),and the operation time was 14-40min.23.7 ± 5.8),24-hour bile drainage volume 180 ~ 705ml (399.6 ± 124.7).Postoperative AST52.3 ± 32.2U/L,ALT 49.8 ±29.7U/L,TB143.8 ±110.2pLmol/L,DB 82.4 ±64.5p,mol/L.Postoperative AST,ALT,TB,DB and preoperative contrast were significantly decreased,the difference was statistically significant (P <0.01).Conclusion :The combined trocar and Seldinger technique in the treatment of obstructive jaundice with ultrasound-guided PTCD in high success rates,few complications.The symptoms of jaundice can be effectively improved,and the liver function can be improved.The catheter into a hard stainless steel casing,increase the hardness and improve the controllability of the inlet pipe direction.It is especially suitable for the treatment of patients with obstructive jaundice with deep location or small inner diameter of targeted bile duct.

关 键 词：套管针法 SELDINGER技术 PTCD 阻塞性黄疸 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575[医药卫生—诊断学]