超声与X线引导内镜胆道引流术的临床研究

Clinical study on ultrasound-guided or X-ray-guided endoscopic biliary drainage

目的比较分析超声与X线引导内镜胆道引流术的置管成功率、疗效及手术并发症。方法比较62例超声引导内镜胆道引流术（超声引导组）和54例X线引导内镜胆道引流术（X线引导组）患者手术前后血清胆红素、胆总管内径和临床症状的变化情况。结果超声引导组62例中54例置管成功，手术前与术后1周患者血清直接胆红素分别为（205．41±115．27）μmol／L及（106．47±82．16）μmol／L（P〈0．05），胆总管内径分别为（12．6±7．1）mm及（8．5±3．1）mm（P〈0．05）。X线引导组54例中51例置管成功，手术前与术后1周患者血清直接胆红素分别为（211．14±106．25）μmol／L及（110．89±59．47）μmol／L（P〈0．05），胆总管内径分别为（13．1±7．0）mm及（8．8±3．2）mm（P〈0．05）。超声引导组术后无腹痛、发热、淀粉酶升高等早期并发症，X线引导组术后有3例（5．9％）出现上述并发症。结论X线仍然是内镜胆道引流术最有效的引导方法。超声引导可避免X线辐射、造影剂过敏等不利因素，且具有实时显示、移动方便，可进行床边急诊、内镜下诊治等优点，可替代X线用于引导所有胆道结石以及狭窄不甚严重的肿瘤患者行鼻胆管引流术和胆道塑料支架引流术。

Objective To compare the successful ratio, efficacy and complications between ultrasound-guided and X-ray guided endoscopic biliary drainage （EBD）. Methods EBD was performed in 62 patients under ultrasound guidance and 54 patients under X ray guidance. Serum bilirubin, the bile duct diameter and the changes of clinical symptoms were compared before and after the procedure. Results Tube placement was successfully achieved in 54 of 62 patients under ultrasound guidance and 51 of 54 patients under X-ray guidance. The serum direct bilirubin and the common bile duct diameter in patients with ultrasound guidance before and one week after procedure were （205. 41±115. 27） μmol/Lvs. （106.47 ± 82.16） μmol/Land （12.6±7. 1） mm vs. （8. 5± 3. 1 ） mm, respectively, with significant difference （all P values 〈0.05 ）. Whereas they were （211. 14±106. 25） μmol/L vs. （110. 89±59. 47） μmol/L and （13.1±7. 0） mm vs. （8. 8± 3. 2） mm, respectively, in patients with X-ray guidance （P 〈 0. 05）. No complications such as abdominal pain, fever and elevated amylase were found in patients with ultrasound guidance, while 3 patients （5. 9 % ） with X ray guidence had above complications. Conclusions X-ray is a most effective method in guidance of EBD. However, ultrasound guidence, which may avoid unfavorable factors such as X-ray radiation and allergic contrast agent, has some advantages including real time display, mobile convenience and emergency bedside application. It can instead of X-ray in performance of endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage in patients with bile duct stone and mild narrow duct caused by tumors.