超声引导在经皮肝胆道镜治疗肝胆管结石中的应用

Application of ultrasonic guidance for percutaneous transhepatic cholangioscopy in treatment of ;hepatolithiasis

目的：探讨超声引导经皮肝胆道镜（PTCS）治疗肝胆管结石的应用价值。方法超声引导下PTCS治疗的95例肝内胆管结石患者，分析超声引导下选择穿刺部位、方向，建立PTCS入路途径、引流窦道的时间，结石取净率，手术并发症等。结果上述病例均经彩超引导穿刺建立PTCS入路途径并置入鞘管、形成瘘道，引流窦道建立时间15～50 min，平均35 min；结石取净率85.0%～88.9%；胆道出血并发症11.6%（11/95）。结论彩超引导结合超声造影能很好辩别胆管与血管，能便捷、准确、较为安全地建立PTCS微创治疗肝胆管结石入路途径、形成引流窦道。

Objective To investigate the value of ultrasonic guidance for percutaneous transhepatic cholangioscopy（PTCS）in treatment of hepatolithiasis. Methods Ninety-five patients with hepatolithiasis received PTCS treatment under ultrasonic guidance were included in the study. The clinical data,including puncture sites and directions under ultrasonic guidance,time of PTCS pathway establishment and sinus drainage, stone clearance rate and surgical complications, were analyzed. Results Color Doppler ultrasound-guided puncture was performed in all patients,and the PTCS pathway was established. Then,the sinus tract was formed with sheath canal placement. The time of establishing sinus drainage was 15～50 min, with a mean time of 35 min. The stone clearance rate was 85.0%～88.9%,and the incidence of biliary tract hemorrhage as a complication was 11.6%（11/95）. Conclusion Color Doppler ultrasonic guidance with ultrasound contrast enhancement can satisfactorily discriminate between bile ducts and blood vessels,and therefore can be used as a convenient,accurate and safe approach to establish the minimally invasive PTCS pathway and sinus tract drainage in treatment of hepatolithiasis.