超声与透视相结合PTCD治疗恶性阻塞性黄疸

Malignant Obstructive Jaundice Treated by PTCD under the Guidance of Ultrasound with Fluoroscopy

目的：探讨通过ＰＴＣＤ内外引流对恶性阻塞性黄疸的治疗价值以及操作方法的改进。材料和方法：１８例恶性阻塞性黄疸，其中肝门部胆管癌１１例，肝门部肝癌４例，胰头癌２例，肝门部胆管癌合并胰头癌１例。治疗前血清总胆红素值８５．０～７８７．８μｍｏｌ／ｌ。采用Ｂ超引导下经皮经肝穿刺肝内胆管，透视下留置引流管，治疗后随访３～２２个月。结果：血清总胆红素值１１３～４３７９μｍｏｌ／Ｌ，平均下降１９８７μｍｏｌ／Ｌ，无严重并发症出现。结论：超声与透视相结合是ＰＴＣＤ成功的关键。超声引导下左侧肝内胆管穿刺的难易度和安全性优于右侧，尤其在有腹水的病例。

Purpose: To study the clinical value of bi-direction drainage by PTCD in the therapy of malignant obstructive jaundice. Materials and Methods: 18 patients with malignant obstructive jaundice were analyzed, including portal cholangiocarcinoma 11 cases, hepatocellcular carcinoma 4 cases, carcinoma in the head of pancreas 2 cases and portal cholangiocarcinoma with carcinoma in the head of pancreas 1 case. The serum total bilirubin before treatment ranged from 85.0 to 787.8μ mol/l. The intrahepatic ducts were punctured under the guidance of ultrasound, and the draining cathaters were placed under the guidance of fluoroscopy. The follow up period ranges from 3 months to 22 months. Results: The serum total bilirubin after treatment ranged from 11.3 to 437.9μ mol/l. The average decretion of the total bilirubin was 198.7 μ mol/l. Conclusion: Ultrasound with fluoroscopy is a key point in PTCD. Puncture in the intrahepatic ducts of the left lobe in easier and safer than that of the right lobe. PTCD is a safe and effective method in treatment of malignant obstructiove jaundice.