双导丝一步Sedilgner穿刺法在经皮肝穿胆管引流术中的应用

目的探讨双导丝一步Sedilgner穿刺法在经皮肝穿胆管引流术(PTCD)中的操作方法及其安全性。方法对86例经CT、MRI、彩色多普勒超声等影像学及血液检查诊断为梗阻性黄疸患者采用22 G Chiba针配合0.033 m、0.064 m双导丝及6 F血管鞘行微创一步法开通穿刺道,其后完成胆管引流的全过程。结果 86例患者中85例置入引流管,手术成功率为98.8%,观察引流效果1周后有20例更换胆道内支架引流。手术早期并发症为15.1%,其中有3例胆心反射(1例停止手术)、5例急性胆管炎、5例血性引流液。结论双导丝一步Sedilgner穿刺法应用在PTCD中是一种经济实用、操作容易、安全性高的微创方法。

Objective To discuss the operation method and security of one-step Sedilgner puncture method with double guidewires in percutaneous transhepatic cholangiography and drainage （PTCD）. Methods Recanalizing puncturing tract by micro-invasion method which used G 22 Chiba needle, combined with double guidewires of 0.033 m and 0.064 m and 6 F vagina vasorum to 86 patients who have been diagnosed obstructive jaundice by imaging examinations like CT, MRI, color Doppler ultrasound and blood examination. Then complete the whole process of biliary drainage. Results 85 cases had implanted drainage tubes among 86 patients and the total success rate was 98.8%. 20 cases had changed biliary stent to drainage in one week after observing drainage effect. The rate of complication in the early stage of surgery was 15.1%among which 3 cases showed biliary-cardiac reflex and one have stopped operation;5 cases presented acute cholangitis;5 cases appeared bloody drainage. Conclusion The applications of one-step Sedilgner puncture method with double guidewires in PTCD is an economical, practical and easy operational micro-invasive treatment with high safety.