超声引导经皮经肝胆管置管引流术在胆道梗阻疾病中的应用

Application of ultrasound-guided percutaneous transhepatic biliary drainage in biliary obstructive diseases

目的评价超声引导经皮经肝胆管置管引流术在无手术适应证胆道梗阻疾病中的应用价值及疗效判断。方法本组39例,男22例,女17例。平均年龄51.2岁。使用自制穿刺辅助装置,日本八光S型引流套管（8F）。选择内径≥10 mm、走行较平坦、无扭曲的胆管为穿刺点,胆管周围加以彩色血流成像并注意避开血管。成功置管的38例中33例行左胆管置管,5例右胆管置管。结果39例除1例因术中出血未成功外,38例均成功置管,随访未发现胆漏、出血、感染等并发症。引流胆汁后患者症状明显改善,血清胆红素逐渐下降,其中6例降至正常。本组胆汁日引流量380～1400 ml。38例中术后生存2～5个月8例、〉6个月15例、〉9个月11例、〉1年4例,最长生存期17个月。结论超声引导肝胆管置管引流,操作简便、痛苦小、成功率高,使患者得到了持续性胆汁引流的机会,对改善梗阻导致的黄疸,减轻由其产生的损害和症状,延长患者生存期及提高晚期生存质量将起到重要的积极作用。

Objective To evaluate the clinical value of ultrasound-guided percutaneous transhepatic biliary drainage （PTBD） in biliary obstructive diseases and its curative effect, Methods PTBD was performed in 39patients （22 men, 17 women） with biliary obstructive diseases using self-made assistant puncture device and model S drainage troear made in Japan. Bile duct which had diameter ≥ 10mm and was smooth and without tortuosity was chosen as puncture point when color Doppler flow imaging was applied to keep it away from blood vessel. Results Among the 39 cases of biliary obstructive diseases, PTBD was completed successfully in 38cases and failed in 1 case because of hemorrhage. In the succedent examination, none had the complications including bile leakage, hemorrhage and infection. The symptoms of patients was alleviated after PTBD, the jaundice of all patients subsided and serum bilirubin of 6 cases decreased to normal. The amount of daily bile drainage was 380-1400 ml. The numbers of patients survived for 2-5 months, over 6 months, over 9 months and over one year after PTBD were 8,15, 11 and 4,respectively. The maximum survival time was 17months. Conclusion Ultrasound-guided PTBD is an effective alternative for bile duct drainage, with advantages of minimal invasion, simplicity of performance, little pain and high success rate, which made patients have the chance of durative bile duct drainage. It presents important clinical value for reducing the jaundice, alleviating the symptoms of patients, prolonging the survival time and improving the life quality of patients in late stage.