超声实时引导下经皮经肝胆管或胆囊穿刺置管引流术治疗急性梗阻性胆管炎在基层医院的应用  

Application of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage in treatment of acute obstructive cholangitis in primary hospitals

作　　者：杨东晓 张勇 王雪峰 李江[2] YANG Dongxiao;ZHANG Yong;WANG Xuefeng(Department of Hepatobiliary Surgery, Tengchong People’s Hospital, Tengchong, Yunnan 679100, China)

机构地区：[1]腾冲市人民医院肝胆外科,云南腾冲679100 [2]昆明医科大学第一附属医院肝胆外科,昆明650032

出　　处：《临床肝胆病杂志》2020年第4期847-849,共3页Journal of Clinical Hepatology

基　　金：昆明医科大学教研教改基金资助项目(2017-JY-Y-091)。

摘　　要：目的探讨在基层医院应用超声实时引导下经皮经肝胆管或胆囊穿刺置管引流术(PTCD)初始治疗急性梗阻性胆管炎患者的临床价值。方法回顾性分析2012年2月-2018年6月在腾冲市人民医院实施超声实时引导下PTCD的38例急性梗阻性胆管炎患者的临床资料,其中4例为恶性胆管梗阻并发胆管炎,34例为肝胆管结石导致急性梗阻性化脓性胆管炎。结果穿刺肝右叶胆管30例,穿刺左叶胆管6例,穿刺胆囊2例。首次进针穿刺成功率为92.1%(35/38),穿刺成功率100%,无出血及胆汁性腹膜炎、胆管血管瘘等并发症,术后2周89.5%(34/38)的患者TBil下降≥1/2,32例(84.2%)患者ALT降至正常范围。34例肝胆管结石患者,感染控制后行胆道探查术取石、肝叶切除术等二期手术,或带管转上级医院进一步治疗;4例肿瘤性胆管梗阻患者带管转上级医院,3例行根治性手术,1例经原穿刺窦道留置胆管支架。结论超声实时引导下PTCD可作为基层医院针对急性梗阻性胆管炎初始治疗的一种有效、简便、安全的减黄技术,其穿刺成功率高﹑对设备要求较低,建议规范技术流程后在基层医院推广应用。Objective To investigate the clinical value of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage(PTCD)in the treatment of patients with acute obstructive cholangitis in primary hospitals.Methods A retrospective analysis was performed for the clinical data of 38 patients with acute obstructive cholangitis who underwent ultrasound-guided real-time PTCD in Tengchong People’s Hospital from February 2012 to June 2018,and among these patients,4 had malignant biliary obstruction and cholangitis and 34 had acute obstructive suppurative cholangitis caused by hepatolithiasis.Results Of all patients,30 underwent puncture of the bile duct in the right lobe of liver,6 underwent puncture of the bile duct in the left lobe of liver,and 2 underwent puncture of the gallbladder.The success rate of first-time needle insertion was 91.2%(35/38),and the overall success rate of puncture was 100%.There were no complications such as massive hemorrhage,biliary peritonitis,and biliary-vascular fistula.At 2 weeks after surgery,89.5%(34/38)of the patients had a bilirubin level reduced by≥1/2,and 32 patients(84.2%)had a level of alanine aminotransferase reduced to normal.As for the 34 patients with hepatolithiasis,second-stage surgeries including bile duct exploration/cholecystolithotomy and hepatic lobectomy were performed after the infection was under control,or they were referred to superior hospitals with tube indwelling for further treatment.The 4 patients with neoplastic bile duct obstruction were referred to superior hospitals with tube indwelling,among whom 3 underwent radical surgery and 1 underwent biliary stent placement via the former deep blind fistula.Conclusion Ultrasound-guided real-time PTCD can be used as an effective,simple,and safe biliary drainage technique for the early treatment of acute biliary obstruction in primary hospitals.This technique has a high success rate and low requirements for medical equipment,and therefore,it holds promise for clinical application in p

关 键 词：黄疸 阻塞性 胆管炎 引流术 基层医院 

分 类 号：R657.45[医药卫生—外科学]