超声引导下PTCD治疗梗阻性黄疸

OBSTRUCTIVE JAUNDICE TREATED BY ULTRASOUND GUIDED PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHIC DRAINAGE

目的 探讨超声引导下PTCD的操作技术及其临床应用价值。方法 15例梗阻性黄疸患者,14例肝门部胆管癌,1例肝癌合并胆总管癌栓,在超声引导下行PTCD术,穿刺肝左叶胆管6例,右叶胆管9例,术后常规胆道造影。结果 穿刺成功率10 0 % ,未出现出血、胆汁性腹膜炎等并发症。术后一周胆红素平均下降80 .5 umol/ L。其中9例不能手术切除的肿瘤患者黄疸减退后带管出院,5例患者经胆道引流黄疸减退后行肿瘤根治性切除,1例肝门部胆管癌合并肝转移患者术后1月死亡。结论 超声引导下PTCD是一种治疗梗阻性黄疸的有效方法,具有安全、并发症少的优点,与X线相结合,可明显提高手术成功率。

Objective To study the clinical application value of the percutaneous transhepatic cholangiographic drainage guided by ultrasound in the therapy of obstructive jaundice. Methods 15 patients with obstructive jaundice were treated by percutaneous transhepatic cholangiographic drainage under guidance of ultrasound, including 14 cases with kelastin cholangiocarcinoma and 1 case with hepatic carcinoma in combination with tumor embolism in the common bile duct. Left lobe drainage was performed in 6 cases, and right lobe drainage was performed in 9 cases. After PTCD cholangiography was conducted in each patient. Result The successful rate was 100%, no complications such as bleeding, bile peritonitis occurred. The average decline of the serum total bilirubin was 80.5umol/L. Among 15 patients, 9 cases who were impossible to be cured by operation leaved hospital after jaundice were regressed, 5 cases underwent operations after PTCD as pre-operation treatment, and 1 case with kelastin cholangiocarcinoma in combination with hepatic metastasis died 1 month after PTCD was performed. Conclusion Percutaneous transhepatic cholangiographic drainage under the guidance of ultrasound is an effective technique, which is safe and has little complication to treat patients with obstructive jaundice. The drainage guided by US combined with the X-ray can increase the successful rate of PTCD.