便携式超声在经皮肝穿刺胃食管静脉曲张栓塞术中应用价值

Application of bedside portable ultrasound in percutaneous transhepatic variceal embolization

目的探讨便携式超声在经皮肝穿刺胃食管静脉曲张栓塞术中的应用价值。方法肝硬化食管-胃底静脉曲张破裂出血患者43例依据就诊时间分为2组,2007年1月—2009年8月行X线引导下经皮肝穿刺胃食管静脉曲张栓塞术20例为X线引导组,2009年9月—2011年2月行便携式超声引导下经皮肝穿刺胃食管静脉曲张栓塞术23例为超声引导组,比较2组穿刺时间、一次穿刺成功率、术中及术后7d并发症发生率等情况。结果超声引导组穿刺时间(11.38±5.13)s,术中及术后7d并发症发生率分别为0、4.35%,均低于X线引导组((126.58±49.25)s、25.00%、30.00%)(P<0.05),一次穿刺成功率(95.65%)高于X线引导组(10.00%)(P<0.05)。结论与X线引导下经皮肝穿刺胃食管静脉曲张栓塞术比较,便携式超声引导下行胃食管静脉曲张栓塞术治疗肝硬化食管-胃底静脉曲张破裂出血可缩短穿刺时间,提高一次穿刺成功率,降低术中及术后并发症发生率。

Objective To explore the value of bedside portable ultrasound to percutaneous transhepatic variceal embolization（PTVE）.Methods Forty-three patients with cirrhosis and upper gastrointestinal bleeding were divided into two groups according to the admission time,in which 20 patients admitted from January 2007 to August 2009 received PTVE under X-ray guidance（X-ray group）,and 23 patients admitted from September 2009 to February 2011 received PTVE under bedside portable ultrasound guidance（ultrasound group）.The puncture time,one-time success rate and the complication incidences during operation and 7-day after operation were compared between two groups.Results The puncture time and the complication incidences during operation and 7-day after operation were（11.38±5.13）s,0and4.35%in ultrasound group,significantly lower than those in control group（（126.58±49.25）s,25.00%,30.00%）（P〈0.05）,and one-time success rate was significantly higher in ultrasound group（95.65%）than that in X-ray group（10.00%）（P〈0.05）.Conclusion PTVE under bedside portable ultrasound guidance can shorten the puncture time,increase the one-time puncture success rate and reduce the incidence of intra-and post-operative complications in the patients with cirrhosis and upper gastrointestinal bleeding in comparison with PTVE under X-ray guidance.