超声结合数字减影血管造影双引导行左肝管经皮肝穿刺胆道引流术的疗效  

Application of ultrasound combined with DSA-guided left hepatic duct PTCD

作　　者：周云 李萍[1] 陈松旺[1] 宋进华 顾建平[3] 邵泽锋 王国品[4] ZHOU Yun;LI Ping;CHEN Song-wang;SONG Jin-hua;GU Jian-ping;SHAO Ze-feng;WANG Guo-pin(Department of Ultrasonography,Nanjing First Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210006,China;不详)

机构地区：[1]南京医科大学附属南京医院南京市第一医院超声科,江苏南京210006 [2]南京医科大学第一附属医院江苏省人民医院肝胆中心,江苏南京210029 [3]南京医科大学附属南京医院南京市第一医院血管介入科,江苏南京210006 [4]南通大学附属南京江北人民医院消化科,江苏南京210048

出　　处：《中国临床研究》2019年第12期1652-1655,共4页Chinese Journal of Clinical Research

基　　金：江苏省2014年省级条件建设与民生科技专项资金(BL2014013);南京市医学科技发展项目(YKK14087)~~

摘　　要：目的通过彩色多普勒超声结合数字减影血管造影(DSA)双引导进行左侧肝管穿刺行胆道引流的临床应用,探讨双引导技术在左侧肝内胆管经皮肝穿刺胆道引流术(PTCD)中的应用价值。方法回顾性分析2016年1月至2019年3月梗阻性黄疸需要进行肝管穿刺引流的60例患者的临床资料,观察组采用彩色多普勒超声结合DSA进行双引导穿刺,对照组采用传统的DSA引导下穿刺,每组30例。对比两组手术时间、穿刺次数、完成置管DSA显示X线剂量、术前术后总胆红素、手术成功率、患者对手术的耐受性。结果观察组手术时间短于对照组[(23.8±5.8)min vs(39.8±8.6)min,P<0.01],穿刺次数[(1.8±0.6)次vs(3.0±1.1)次,P<0.01]、完成置管DSA显示X线剂量[(167.5±55.6)mGy vs(816.7±420.7)mGy,P<0.01]少于对照组。两组术前、术后总胆红素水平比较无统计学差异(P>0.05)。对照组有6例感觉极为难受,1例因此停止操作,外引流失败;观察组仅有1例感觉极为难受。观察组患者手术耐受情况优于对照组(P<0.05)。观察组30例全部成功完成置管引流术,手术成功率100%;对照组29例完成置管引流术,手术成功率93.3%。两组手术成功率比较无统计学差异(P>0.05)。结论彩色多普勒超声结合DSA双引导进行左侧肝管穿刺行胆道引流安全可行,可缩短手术时间,减少穿刺次数,提高手术成功率,可以发挥两种影像设备各自的优势。Objective To investigate the clinical application of double-guided technique of color Doppler ultrasonography combined with digital subtraction angiography(DSA)inpercutaneous transhepatic cholangial drainage(PTCD)of the left intrahepatic bile duct.Methods A retrospective study was performed in 60 patients with obstructive jaundice treated from January 2016 to March 2019.The patients were divided into observation group in which color Doppler ultrasound combined with DSA for double guided PTCD was conducted and control group in which traditional DSA guided PTCD was performed(n=30,each).The time of operation,the number of puncture,the X-ray dose of DSA after completion of catheterization,the total bilirubin levels before and after operation,the operation success rate and the tolerance of patients to operation were compared between two groups.Results The operation time[(23.8±5.8)min vs(39.8±8.6)min,],the number of punctures(1.8±0.6 vs 3.0±1.1),the X-ray dose of DSA after completion of catheterization[(167.5±55.6)mGy vs(816.7±420.7)mGy]in observation group were significantly shorter than those in control group(all P<0.01).The tolerance of the patients in observation group was better than that in control group(P<0.05).There was no significant difference in total bilirubin levels between two groups before and after operation(P>0.05).In control group,6 patients felt extremely uncomfortable during operation with procedure stopped and external drainage failed in one case;in observation group,only 1 patient felt extremely uncomfortable during operation.PTCD were successfully completed in 30 cases of observation group(100%)and in 29 cases of control group(93.3%).There was no significant difference in successful rate between two groups(P>0.05).Conclusion Color Doppler ultrasound combined with DSA double guidance for drainage of the left hepatic duct with PTCD is safe and feasible.It can shorten the operation time,reduce the number of puncture,improve the success rate of the operation and play the advantages of the two k

关 键 词：彩色多普勒超声 数字减影血管造影 左肝管穿刺 经皮肝穿刺胆道引流术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.8[医药卫生—诊断学]