超声引导下经皮经肝胆道穿刺引流术治疗胆肠吻合术后急性重症胆管炎的临床价值

Clinical value of ultrasound-guided PTCD in the treatment of acute cholangitis of severe type after bilioenterostomy

目的总结超声引导下行经皮经肝胆道穿刺引流术（PTCD）的临床价值。方法对一期无法行手术治疗的36例胆肠吻合术后急性重症胆管炎患者选择超声引导下行PTCD治疗。结果36例均穿刺成功，除1例患者穿刺导管出院后不慎滑脱外，其余患者均元胆道出血、胆汁性腹膜炎等并发症，根据胆汁培养与药敏分析选择抗生素治疗效果确切，高热等中毒危象缓解，黄疸消退，肝功能改善。结论超声引导下PTCD创伤小，治疗效果确切，操作简单、迅速。对复杂胆道术后再次发作急性重症胆管炎，合并高龄、心肺基础疾病无法耐受手术患者，可作为急救措施，为择期根治性治疗赢得机会。

Objective To summarize the clinical value of ultrasound-guided percutaneous tran- shepatic cholangial drainage（PTCD）. Methods A total of 36 patients who could not be operated by one- stage operation received ultrasound-guided PTCD for acute cholangitis of severe type after bilioenterosto- my. Results All 36 cases of patients were punctured successfully without complications such as biliary bleeding and bile peritonitis, but one patient＇s puncture catheter accidentally slipped after hospital discharge. There were good effects of antimicrobial therapy according to the drug sensitive test of bile culture, such as the relief of high fever,jaundice and liver function. Conclusion PTCD is efficacious procedure with minimal trauma and easy operation. In the treatment of acute cholangitis of severe type after complex biliary surgery,it can be chosen as emergency treatment for inoperable patients who are in a serious condition with underlying cardiopulmonary diseases or aged and win chances for selective radical surgery.