超声引导下经皮肝穿刺胆管置管引流术治疗梗阻性黄疸

Ultrasound-guided percutaneous transhepatic cholangiographic drainage in treatment of obstructive jaundice

目的探讨超声引导下经皮肝穿刺胆管置管引流术治疗梗阻性黄疸的临床价值。方法对39例梗阻性黄疸患者行超声引导下经皮肝穿刺胆管置管引流术,包括胆管癌23例,胰头癌9例,化脓性胆管炎伴胆管结石4例,壶腹部肿瘤3例。结果行右肝管穿刺24例,左肝管穿刺10例,同时行左右肝管穿刺5例。所有患者均一针穿刺成功,成功率100%;术后血清总胆红素、直接胆红素、碱性磷酸酶、丙氨酸转氨酶和γ-谷氨酰转移酶均显著下降(P均<0.05)。结论超声引导下经皮肝穿刺胆管置管引流术具有定位准确、操作简便、创伤小、并发症少等优点,能在短期内有效降低体内胆红素水平,对于肝功能的恢复及后续治疗具有一定临床价值。

Objective To observe the clinical value of ultrasound-guided percutaneous transhepatic cholangiographic drainage （PTCD） for the treatment of obstructive jaundice. Methods PTCD was performed under the guidance of ultra- sound in 39 patients with obstructive jaundice, including 23 with cholangiocarcinoma, 9 with pancreatic head carcinoma, 4 with suppurative cholangitis complicated with bile duct calculi, and 3 with ampullary sulcus tumor. Results PTCD was successfully performed through right hepatic duct in 24 patients, through left hepatic duct irl 10 and through both ducts in 5 patients. Among all patients, the successful rate for one session was 100%. The serum levels of total bilirubin, direct bilirubin, alkaline phosphatase, alanine aminotransferase and y-glutamyl transferase significantly decreased in all the pa- tients after PTCD （all P〈0.05）. Conclusion Ultrasound-guided PTCD has advantages such as accurate positioning, sim- ple operation, minimal invasion, fewer complications and so on, and can reduce the level of bilirubin in short term, thus having certain clinical value for the recovery of liver function and subsequent treatment.