彩色多普勒超声引导下经皮经肝穿刺胆道引流术序贯数字减影血管造影透视下胆总管支架植入术治疗梗阻性黄疸40例体会

Percutaneous transhepatic cholangial drainage sequential common bile duct stenting for obstructive jaundice:40 cases report

目的探讨彩色多普勒超声引导下经皮经肝穿刺胆道引流术（PTCD）序贯数字减影血管造影（DSA）透视下胆总管支架植入术治疗梗阻性黄疸的操作技术的可行性、安全性及其临床应用价值。方法40例梗阻性黄疸患者,在彩色多普勒超声引导下行PTCD术,术后引流7 d后,在DSA透视下,经PTCD引流管造影,再行胆道支架植入术。结果 PTCD穿刺成功率为100%,引流管留置7 d,术后每日胆汁引流量在150~800 ml,术后1周胆红素平均下降75.4μmol/L。其中有36例患者胆红素下降至50μmol/L以下,有32例患者自觉症状有缓解。在DSA透视下,胆总管支架植入术成功率高达100%。结论彩色多普勒超声引导下PTCD序贯DSA下胆总管支架植入术是一种治疗梗阻性黄疸的有效方法,具有安全、有效、简便、可重复性等优点,减少了盲目穿刺和出血的风险。

Objective To investigate the feasibility,safety and clinical value of ultrasound-guided percutaneous transhepatic cholangial drainage（PTCD） sequential with digital subtraction angiography（DSA） guided common bile duct stenting for obstructive jaundice.Methods Forty patients with obstructive jaundice underwent common bile duct stenting guided by angiography of PTCD drainage tube via DSA,7 days after ultrasound-guided PTCD.Results Success rate of PTCD puncture was 100%.Bile drainage per day went from 150 ml to 800 ml during 7 days after PTCD.One week after the operation bilirubin level decreased in average of 75.4 μmol/L.Lower than 50 μmol/L of bilirubin level was presented in 36 cases,and 32 of them felt much better consciously.And with the guidance of DSA,the success rate of common bile duct stenting is up to 100%.Conclusion Ultrasound-guided PTCD sequential with DSA guided common bile duct stenting is a safe,effective,convenient,repeatable method for the treatment of obstructive jaundice.And it can reduce the risk of bleeding resulting from blind puncture.