DSA下联合超声定位在经皮经肝穿刺胆道恶性梗阻引流术中的应用价值

Application of DSA guidance combined with ultrasound localization in performing percutaneous transhepatic biliary drainage

目的探讨DSA下联合超声在经皮经肝穿刺胆道恶性梗阻引流术(PTBD)中的应用价值。方法对32例恶性肿瘤所致的梗阻性黄疸(其中原发性肝癌4例,胆管癌21例,胆囊癌肝门转移2例,转移癌3例,胰头癌2例),在DSA下联合超声定位穿刺进行姑息性胆道外或内外引流,术后常规复查生化全项。结果 32例患者应用该方法定位好后均一针穿刺并引流成功,成功率100%,其中21例外引流,11例内外引流,达到了减轻黄疸,改善肝功能和相关症状,提高患者生活质量的目的。结论在PTBD操作时,应用DSA下联合超声定位能显著提高成功率,是一种安全有效的方法 ,有助于减轻患者痛苦,同时很大程度减少了患者和介入医师射线照射剂量。

Objective To investigate the application of DSA guidance combined with ultrasound localization in performing percutaneous transhepatic biliary drainage（PTBD）.Methods A total of 32 cases with malignant obstructive jaundice were enrolled in this study.The primary malignancy included primary liver cancer（n = 4）,bile duct carcinoma（n = 21）,gallbladder carcinoma with hepatic hilar metastases（n = 2）,metastatic carcinoma（n = 3） and adenocarcinoma of the head of pancreas（n = 2）.Palliative biliary tract external and/or internal drainage were carried out under DSA guidance together with ultrasonic localization.After the treatment,all the routine biochemical items were reexamined.The results were analyzed.Results Successful puncturing and drainage with single manipulation was achieved in all the 32 patients,and the success rate was 100%.External drainage was employed in 21 cases,while external together with internal drainage was adopted in 11 cases.After the operation,the jaundice was reduced,the liver function and clinical symptoms were relieved,and the patient＇s living quality was improved.Conclusion With the help of DSA guidance combined with ultrasound localization the technical success rate of PTBD can be greatly improved and the operation time can be shortened.This technique is safe and effective,and it is very helpful in reducing patient＇s suffering.Meanwhile,the exposure dose of irradiation can be lessened to a large extent.（J Intervent Radiol,2012,21： 69-71）