彩色多普勒超声引导经皮门静脉穿刺置管的应用及注意事项

Clinical application of hepatic portal vein puncture under color Doppler ultrasonic guidance and indwelling catheter

目的探讨彩色多普勒超声引导下经皮经肝穿刺门静脉留置导管的临床应用价值。方法 65例临床需要经门静脉给药治疗的肝脏疾病患者,在彩色多普勒超声引导下经皮经肝穿刺门静脉置入中心静脉导管,观察穿刺及置管成功率、导管留置天数、并发症发生率等。结果 65例中,穿刺一次成功率96.9%(63/65),置管一次成功率96.9%(63/65),导管留置天数,早期病例(8例)为7～14d,平均(9.2±2.7)d,改进后(57例)为23～40 d,平均(34.7±8.5)d;并发症发生率0%(0/65)。经门静脉注药治疗原发性肝癌、转移性肝癌及慢性重度肝炎的疗效优于外周静脉给药。结论该方法可重复门静脉给药,能增加局部药物浓度,提高药物治疗效果,并且安全、可靠,无严重并发症。

Objective： To discussing the clinical application value of hepatic portal vein puncture with color Doppler ul- trasonic guidance and indwelling catheter. Methods： Sixty-five patients with liver disease underwent percutaneous transhe- patic portal puncture and insertion of central venous catheter under the corlor Doppler ultrasonic guidance. The success rati- o of puncture and indwelling catheter,bretention catheter days and the incidence of complications were recorded. Results ： In the 65 cases, the success ratio of puncture and indweUing catheter was 96.9 percent. The retention catheter days in earlier cases （8 eases） were 7 to 14 days , 9.2 ± 2.7 days on average, while in improved eases （57 cases） they were 23 -40 days, 34.7 ± 8.5 on average. There were significant differences between the two but both had no any complications. As to the therapeutic effect on treating HCC, MHC and CH-B, the method intraportal administration was superior to PV adminis- tration. Conclusion： The method can be used for intraportal administration repeatedly to increase local drug concentrations and enhance the effectiveness of drug treatment. As a new way to treat liver diseases, it is safe, reliable with no serious complications and worth being promoted and applied.