经皮肝胆管穿刺置管术治疗恶性肿瘤致胆道梗阻的临床价值

Ultrasound-guided percutaneous transhepatic cholangial drainage in treatment of patients with neoplasm-induced obstructive jaundice

目的探讨经皮肝胆管穿刺置管引流术的临床应用价值。方法在超声引导下对130例梗阻性黄疸患者进行经皮肝胆管穿刺置管引流术,观察对临床症状和黄疸的改善情况。结果130例患者穿刺置管引流术均置管成功,其中选择右肝管前支穿刺置管的一次成功率达94.0%(79/84),左肝管外下支一次成功率为81.2%(26/32),右肝管一次成功率为85.7%(6/7),左肝管一次成功率为66.7%(2/3),肝总管一次成功率为75%(3/4)。穿刺胆管内径5～20mm,平均11mm,患者临床症状明显改善,黄疸大幅下降。结论在超声引导下经皮肝胆管穿刺置管引流术具有安全、可靠、实时、准确的特点,有很高的临床应用价值,选择右肝管前支穿刺置管成功率较其他入路高。

Objective To discuss the clinical value of ultrasound-guided percutaneous transhepatic cholangial drainage in the treatment of patients with neoplasm-induced obstructive jaundice. Methods 130 obstructive jaundice patients received percutaneous transhepatic cholangial drainage under ultrasonic guidance. The drainage catheters were placed in the anterior branch of the right biliary duct in 84 cases,in the inferior segmental biliary duct of the left lateral lobe in 32 cases,in the right hepatic duct in 7 cases,in the left hepatic duct in 3 cases,and in the common hepatic duct in 4 cases. Results The successful rate of total centesis in 130 patients was 100%. The diameters of biliary duct ranged from 5 to 20 mm with mean llmm. Patients were alleviated obviously both clinically and biochemically. Conclusion Application of percutaneous transhepatic cholangial drainage under US-guidance is a safe,reliable,real-time and accurate technique. Choice of the anterior branch of the right biliary duct for the operation is more effective compared with other ways.