普通超声探头引导经皮经肝胆管穿刺置管引流的临床意义及方法探讨

Clinical significance and study of operation method of PTBD guided by ordinary ultrasonic probe

目的 探讨普通探头引导经皮经肝胆管穿刺置管引流 (PTBD)的临床意义及操作方法。方法 恶性肿瘤所致肝外阻塞性黄疸患者 2 5例 ,经B超、CT、胆管造影确诊 ,其中 17例经手术证实。所有患者均使用普通凸阵探头引导行PTBD。结果 2 5例共行 3 0例次PTBD ,2 4例 ( 2 9例次 )置管引流成功 ,手术成功率达 96.7% ( 2 9/ 3 0 ) ,成功置管的 2 9例次中 1次穿刺成功达 89.7% ( 2 6/ 2 9)。成功手术的 2 4例患者术后 1周黄疸明显减退者 19例 ( 79.2 % ) ,无明显减退者 4例 ( 16.7% ) ,3d后脱管未再行PTBD者 1例( 4 .2 % )。结论 普通超声探头引导PTBD具有方便灵活的特点 ,其操作方法值得深入探讨与掌握。

Objective To probe the clinical significance and the operation method of the percutaneous transhepatic bile drainage(PTBD) guided by the ordinary ultrasonic probe.Methods Twenty five patients with extrahepatic cholestatic jaundice caused by malignant tumors were examined by ultrasound,CT and cholangiography,17 of them were verified by operations.The ordinary curve probe was used to guide PTBD in all the patients.Results Thirty times of PTBD were carried out in the 25 patients.Among them 24 patients (29 times) were successfully operated.The successful rate was 96.7 (29/30).Among 29 operations the successful rate of puncture for once was 89.7 %(26/29).Among 24 patients who had been successfully undergone PTBD,jaundice was obviously abated in 19 patients ( 79.2 %),yet not obviously abated in four patients( 16.7 %).The drainage tube went out of the body in one patient( 4.2 %) 3 dyas later after PTBD and he did not accept to undergo PTBD once more.Conclusions The ordinary ultrasonic probe has the features of convenience and flexibility.The operation method is worth to be deeply probed and mastered.