彩色多普勒超声引导下经皮经肝胆管引流术的临床应用价值

Clinical Value of Percutaneous Transhepatic Cholangial Drainage under the Guidance of Color Doppler Ultrasound

目的探讨彩色多普勒超声在经皮经肝胆管穿刺置管引流术中的临床应用价值,提高经皮经肝胆管穿刺置管引流术的成功率。方法应用彩色多普勒超声引导对46例梗阻性黄疸患者进行54人次经皮经肝胆管穿刺置管引流术,其中选择左外叶下段支胆管进针置管者34例38人次,右前叶支胆管进针置管者12例18人次,均将引流管置入患者扩张的胆管内并保留。结果46例54人次经皮经肝胆管穿刺置管引流术成功率100%,其中1次性成功率占87%(40/46),2次性成功率占8.7%(4/46),3次性成功率占4.35%(2/46)。其中选择左外叶下段支胆管穿刺置管1次性成功率达91%(31/34),右前叶支胆管1次性成功率为75%(9/12)。穿刺胆管扩张范围为3～11mm。患者临床症状均明显改善。结论彩色多普勒超声引导下的经皮经肝胆管引流术具有穿刺置管简便、实时、安全、微创、准确率高的优点,选择左外叶下段支胆管穿刺置管成功率较右叶支高。

Objective To discuss the clinical value of ultrasonically guided Percutaneous Transhepatic Cholangial Drainage （PTCD）in order to improve the success rate. Methods Fifty-four PTCDs were operated in 46 obstructive jaundice patients under the guidance of color doppler ultrasound. Thirty-eight PTCDs were carried out in 34 patients by passing through the inferior segmental biliary duct of the left lateral lobe. Sixteen PTCDs were performed in 12 patients through the anterior branch of the right biliary duct. Finally, tube were inserted to the target biliary duct in all cases. Results The successful rates of once centesis,twice centesis and thrice centesis were 87% ,8.7% and 4.35 % respectively. The successful rates of once PTCD were 91% when punctured by the inferior segmental biliary duct of the left lateral lobe, while the successful rates were only 75N when punctured by the anterior branch of the right biliary duct. The diameters of biliary duct were ranged from 3 to 11 mm. Patients were alleviated obviously after PTCD. Conclusion Application of PTCD under the guidance of color doppler ultrasound is safe and effective. Choice of the inferior segmental biliary duct of the left lateral lobe for PTCD is more effective compared with other ways.