超声引导下经皮肝胆道穿刺引流术治疗梗阻性黄疸的应用价值

Application value of ultrasound-guided percutaneous transhepatic cholangial drainage in the treatment of obstructive jaundice

目的探讨超声引导下经皮肝胆道穿刺引流术治疗梗阻性黄疸的应用价值。方法回顾分析57例梗阻性黄疸患者的临床资料,所有患者均在超声引导下经皮肝胆道穿刺引流术进行治疗,观察治疗效果,并比较手术前后患者肝功能指标变化情况。结果 57例患者中一次置管成功50例,占87.7%;二次成功3例,总成功率为93.0%;穿刺失败4例(原因为胆管过细,均为4 mm)。与术前比较,术后3、14 d血清总胆红素、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)均显著下降,差异具有统计学意义(P<0.05)。结论超声引导下经皮肝胆道穿刺引流术治疗梗阻性黄疸的效果较好,一次穿刺成功率较高,能有效改善患者肝功能,促进黄疸消退,值得推广应用。

Objective To investigate application value of ultrasound-guided percutaneous transhepatic cholangial drainage in the treatment of obstructive jaundice. Methods A retrospective analysis was made on clinical data of 57 patients with obstructive jaundice. All patients received ultrasound-guided percutaneous transhepatic cholangial drainage for treatment, and their curative effects were observed, along with comparison on liver function index changes before and after operation. Results Among 57 cases, there were 50 cases with first successful catheterization, accounting for 87.7%, 3 cases with second successful catheterization, and the total success rate was 93.0%. There were 4 failed cases（due to extremely thin bile duct as 4 mm）. Comparing with those before operation, postoperative reexamination in 3 and 14 d showed all lower serum total bilirubin, alanine aminotransferase（ALT）and aspartate aminotransferase（AST）, and the difference had statistical significance（P〈0.05）. Conclusion Ultrasound-guided percutaneous transhepatic cholangial drainage shows precise effect in the treatment of obstructive jaundice, along with high success rate in first catheterization. This method can effectively improve liver function in patients and accelerate jaundice recession, and it is worth promoting and applying.