DSA联合MRCP融合导航经皮肝穿刺胆管引流治疗高位恶性胆道梗阻的临床效果  

Clinical effect of digital subtraction angiography combined with MRCP fusion navigation percutaneous transhepatic cholongial drainage in the treatment of high malignant biliary obstruction

作　　者：曹莉明 张勇学 崔进国 刘佩 陈静 赵红恩 王敏 刘珊 康志龙 CAO Liming;ZHANG Yongxue;CUI Jinguo;LIU Pei;CHEN Jing;ZHAO Hongen;WANG Min;LIU Shan;KANG Zhilong(Department of Interventional Therapy,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China;Department of Reproductive Medicine,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China;Department of Thoracic surgery,Xinle People's Hospital,Xinle 050000,China)

机构地区：[1]中国人民解放军联勤保障部队第九八〇医院(白求恩国际和平医院)介入治疗科,河北石家庄050082 [2]中国人民解放军联勤保障部队第九八〇医院(白求恩国际和平医院)生殖医学科,河北石家庄050082 [3]河北省新乐市人民医院胸外科,河北新乐050000

出　　处：《医学影像学杂志》2024年第11期78-81,共4页Journal of Medical Imaging

基　　金：河北省医学科学研究课题计划项目(编号:20242387)。

摘　　要：目的探讨数字减影血管造影(digital subtraction angiography DSA)联合磁共振胆道水成像(MRCP)影像融合引导经皮肝穿刺胆管引流(percutaneous transhepatic cholongial drainage,PTCD)治疗高位恶性梗阻性黄疸的有效性及安全性。方法选取我院60例高位恶性梗阻性黄疸行PTCD治疗的患者临床资料。根据穿刺引导方式不同分为常规PTCD组30例和影像融合PTCD组30例。比较两组间靶胆管穿刺成功次数、对比剂用量、X线曝光剂量、时间及并发症发生情况。结果两组基本资料比较差异无统计学意义,具有可比性。常规PTCD组共行穿刺引流42次,其中肝左叶胆管引流14次,肝右叶胆管引流28次;影像融合PTCD组共行穿刺引流40次,肝左叶胆管引流14次,肝右叶胆管引流26次,两组比较差异无统计学意义(P>0.05);常规PTCD组与影像融合PTCD组胆管穿刺次数、对比剂用量、X线曝光剂量及时间分别为(3.6±0.5)vs(1.7±0.4)次,(98.5±21.3)vs(45.7±16.5)ml,(548.2±63.5)mGy vs(298.5±50.8)mGy,(56.5±6.2)min vs(30.4±5.2)min,两组间差异有统计学意义(P<0.05),影像融合PTCD组优于常规PTCD组,差异有统计学意义(P<0.05)。影像融合PTCD组并发症发生率为6.7%,低于常规PTCD组(26.7%),差异有统计学意义(P<0.05)。结论应用MRCP与DSA影像融合导引实施PTCD治疗高位恶性梗阻性黄疸安全可行,可指导介入治疗医师减少胆管穿刺次数、缩短X线辐射时间及曝光剂量,减少对比剂用量。Objective To investigate the efficacy and safety of percutaneous transhepatic cholongial drainage guided by digital subtraction angiography combined with MRCP image fusion in the treatment of high malignant obstructive jaundice.Meth⁃ods Clinical data of 60 patients with high malignant obstructive jaundice treated with PTCD in our center were studied.The patients were divided into conventional PTCD group(30 cases)and image fusion PTCD group(30 cases)according to different puncture guidance methods.The number of target bile duct puncture,dosage of contrast agent,X-ray exposure dose,exposure time and complications of the two groups were recorded.Results The basic data of the two groups showed no statistical differences and were comparable.In the conventional PTCD group,42 times of puncture drainage were performed,including 14 times of left hepatic bile duct drainage and 28 times of right hepatic bile duct drainage.PTCD group underwent puncture drainage for 40 times,left hepatic bile duct drainage for 14 times and right hepatic bile duct drainage for 26 times,with no statistical differences.The bile duct puncture times,contrast agent dosage,X-ray exposure dose and time of conventional PTCD group and image-fusion PTCD group were(3.6±0.5)vs(1.7±0.4)times,(98.5±21.3)vs(45.65±16.5)ml,(548.2±63.5)mGy vs(298.46±50.8)mGy,(56.5±6.2)min vs(30.4±5.2)min,respectively.There were statistical differences between the two groups,the image fusion PTCD group was better than the conventional PTCD group(P<0.05),the difference was statistically significant(P<0.05).The complication rate of image fusion group was 6.67%,which was better than that of conventional PTCD group(26.7%),and the difference was statistically significant(P<0.05).Conclusion The application of MRCP and DSA image fusion to guide PTCD in the treatment of high malignant obstructive jaundice is safe and feasible,which can guide the interventional physician to reduce the number of bile duct puncture,shorten the time and exposure of X-ray radiation,and reduce the d

关 键 词：经皮肝穿刺胆管引流术 胆管癌 肝癌 数字减影血管造影 介入性 放射学 

分 类 号：R575.7[医药卫生—消化系统] R815[医药卫生—内科学]