B超引导经皮肝穿刺胆道引流治疗阻塞性黄疸80例

Application of percutaneous transhepatic cholangial drainage in eighty cases with obstructive jaundice under ultrasonic guidance

目的探讨B超引导经皮肝穿刺胆道引流术（percutaneous transhepatic cholangial drainage,PTCD）治疗阻塞性黄疸的临床价值。方法回顾性分析广州中医药大学第一附属医院2009年5月至2012年5月80例阻塞性黄疸病例采用PTCD治疗的临床资料,总结放置PTC管数、平均手术时间、术后24 h胆汁引流量,并对比分析手术前后血清总胆红素水平（TB）差异。结果 80例患者穿刺放置PTC管95根,留置时间为7~185（45±21）d。平均手术时间为（30±15）min,术后24 h胆汁引流量为（415±214）ml。术后1周TB均值（μmol/L）与术前相比明显下降,差异有统计学意义（116±56vs 354±150,t=17.030,P〈0.01）。术后2周TB降至（57±36）μmol/L,与术后1周TB相比,差异有统计学意义（t=10.621,P〈0.01）。发生胆汁漏及胆道出血并发症共2例（2.5%）。结论 B超引导PTCD术具有微创、安全的优点,是治疗阻塞性黄疸有效方法之一。

Objective To explore the clinical value of ultrasound-guided percutaneous transhepatic cholangial drainage（PTCD） in the treatment of obstructive jaundice. Methods Eighty patients with obstructive jaundice who underwent ultrasound-guided PTCD in our hospital from May 2009 to May 2012 were followed up,and their records such as PTC tube number,the average operation time,postoperative 24 h bile drainage and serum total bilirubin level were summarized retrospectively. Results Ninety-five PTC tubes were inserted in eighty patients,and the average indwelling time was 7-185（45±21） d. The mean time of operation was（30±15） min. The drainage of 24 hours after operation was（415±214） ml. Serum total bilirubin of patients at time of two weeks after operation,one weeks after operation and pre-operation were（57±36）μmol/L,（116±56）μmol/L,and（354±150） μmol/L,P 0.01. Bile leakage and hemobilia occurred in two patients（2.5%）. Conclusion Ultrasound-guided PTCD is a good choice for obstructive jaundice,for it is minimally invasive and safe.