超声引导联合X线透视一体化进行经皮肝穿刺胆管引流的临床研究  

Clinical study of ultrasound guidance combined with X-ray fluoroscopy for percutaneous transhepatic biliary drainage

作　　者：岳天华 袁鹏 陈法警 俞先奇 赵辉[3] YUE Tianhua;YUAN Peng;CHEN Fajing;YU Xianqi;ZHAO Hui(Department of Interventional Radiology,the Affiliated Jianhu Hospital of Nantong University Xinglin College,Jianhu,Jiangsu Province 224700,China;Department of Ultrasound,the Affiliated Jianhu Hospital of Nantong University Xinglin College,Jianhu,Jiangsu Province 224700,China;Department of Interventional Radiology,the Affiliated Hospital of Nantong University,Nantong,Jiangsu Province 226001,China)

机构地区：[1]南通大学杏林学院附属建湖医院介入放射科,江苏建湖224700 [2]南通大学杏林学院附属建湖医院超声科,江苏建湖224700 [3]南通大学附属医院介入放射科,江苏南通226001

出　　处：《实用放射学杂志》2025年第2期297-301,共5页Journal of Practical Radiology

基　　金：盐城市医学科技发展计划项目(YK2021080)。

摘　　要：目的探讨超声引导联合X线透视一体化进行经皮肝穿刺胆管引流(PTBD)的应用价值。方法选取157例行PTBD的梗阻性黄疸患者,根据引导方式不同分为对照组(75例)和观察组(82例)。对照组在传统的X线透视引导下穿刺胆管并置管。观察组采用超声引导下穿刺胆管,X线透视下置管。对比2组穿刺成功率、手术成功率、首针穿刺成功率、穿刺次数、手术时间、X线透视时间、辐射剂量及并发症发生率。结果2组患者均穿刺、置管成功,穿刺成功率及手术成功率均为100%。观察组首针穿刺成功率(90.24%,74/82)高于对照组(74.67%,56/75);平均穿刺次数(1.14次)少于对照组(1.77次);平均手术时间(30.02 min)少于对照组(40.09 min);平均X线透视时间(4.03 min)少于对照组(6.61 min);平均辐射剂量(49.08 mGy)少于对照组(82.29 mGy),2组比较差异有统计学意义(P<0.05)。观察组中发生胆道出血2例,胆道感染3例,胆汁瘘5例(其中2例继发胆汁性腹膜炎),而对照组中胆道出血10例,胆道感染15例,胆汁瘘13例,胆汁性腹膜炎9例,2组比较差异有统计学意义(P<0.05)。结论超声引导联合X线透视一体化进行PTBD安全有效,明显缩短手术时间、辐射剂量低且并发症少,在各级医院中具有一定的普及意义。Objective To investigate the application value of ultrasound guidance combined with X-ray fluoroscopy for percutaneous transhepatic biliary drainage(PTBD).Methods A total of 157 patients with obstructive jaundice who underwent PTBD were selected and then divided into a control group(75 cases)and an observation group(82 cases)according to different guidance methods.The control group underwent puncture and catheterization of the biliary system under the guidance of traditional X-ray fluoroscopy.Meanwhile,the observation group underwent the puncture to the biliary system under ultrasound guidance and the catheterization under X-ray fluoroscopy.The success rates of puncture,operation and initial needle puncture,puncture times,operation time,X-ray fluoroscopy time,radiation dose and complication rate were compared between the two groups.Results Puncture and catheterization were successful in both groups,and the success rates of puncture and operation were all 1oo%.In the observation group,the success rate of initial needle puncture was 90.24%(74/82),which was higher than 74.67%(56/75)in the control group;the mean puncture times was 1.14,which was less than 1.77 in the control group;the mean operation time was 30.02 min,which was less than 40.09 min in the control group;the mean X-ray fluoroscopy time was 4.03 min,which was less than 6.61 min in the control group;the mean radiation dose was 49.08 mGy,which was less than 82.29 mGy in the control group,and all the differences above between the two groups were statistically significant(P<0.05).In the observation group,there were 2 cases with biliary hemorrhage,3 cases with biliary infection,and 5 cases with biliary fistula(including 2 cases of secondary biliary peritonitis);while the control group had 10 cases with biliary hemorrhage,15 cases with biliary infection,13 cases with biliary fistula and 9 cases with biliary peritonitis,and the differences between the two groups were statistically significant(P<0.05).Conclusion Ultrasound guidance combined with X-ray fluoroscop

关 键 词：经皮肝穿刺胆管引流 超声引导 X线透视 梗阻性黄疸 

分 类 号：R815[医药卫生—放射医学] R445.1[医药卫生—临床医学] R575.6