经皮肝穿刺胆管引流术的常见并发症及防治

Common complication of percutaneous transhepatic cholangic drainage and its prevention

目的分析经皮肝穿刺胆管引流术(PTCD)的常见并发症,提出防治措施。方法对220例接受PTCD治疗的梗阻性黄疸患者的资料进行回顾性分析。结果 220例患者中,218例为肝外梗阻性黄疸,其中良性梗阻9例,恶性梗阻209例;2例为肝内梗阻性黄疸,其中硬化性胆管炎1例,肝转移瘤肝内胆管广泛受侵1例。穿刺成功率为99.09%,穿刺失败的2例均为肝内梗阻性黄疸。9例患者于PTCD术后24～72h内死亡。PTCD术中出现胆心反射35例,术后出血6例,感染16例,胸膜损伤3例,胆汁性腹膜炎1例,急性肾衰竭1例,引流管脱出14例,胆汁过度分泌1例,急性前壁心肌梗死1例。结论 PTCD的并发症种类较多,一些严重的并发症可导致患者死亡,但通过术前充分准备、术中及术后积极处理,可有效防止多数并发症的发生。

Objective To analyze the complications of percutaneous transhepatic cholangic drainage（PTCD）and the prevention measures.Methods The data of 220 patients with obstruction jaundice who underwent PTCD were retrospectively analyzed.Results Among all 220 patients,extrahepatic obstructive jaundice was detected in 218 patients,including 9 benign obstruction and 209 malignant obstruction.Intrahepatic obstructive jaundice was found in 2 patients,including 1 of sclerosing cholangitis and 1 of liver metastasis with diffuse invasion of intrahepatic bile duct.Puncture was successful in 218（218/220,99.09%）patients with extrahepatic obstructive jaundice,but not in the 2 cases of intrahepatic jaundice.Nine patients died 24—72 h after PTCD.Intraoperative gallbladder-cardiac reflex was observed in 35 patients,hemorrhage in 6,biliary infection in 16,pleural injury in 3,while biliary peritonitis,acute renal failure,bile excessive secretion,acute myocardial infarction in anterior wall after the operation occurred in one case,respectively.Drainage tube dislocation occurred in 14 patients.Conclusion Complications frequently occur in patients treated with PTCD.Some of the serious complications may lead to death,but most of them can be prevented with positive treatment.