导丝两点牵引法在经皮经肝窦道扩张中的初步应用

A preliminary study on the application of two-point traction with guidewire method in per＇Cutaneous transhepatic sinus tract dilation

目的探讨导丝两点牵引法在提高经皮经肝窦道扩张安全性中的可行性及有效性。方法回顾性分析中国医科大学附属盛京医院2013年1月至2017年7月共18例采用导丝两点牵引法行经皮经肝窦道扩张患者的临床资料，观察手术时间、术中出血量、术后并发症发生情况等。结果18例患者均顺利完成窦道扩张操作，扩张后的经皮肝窦道尺寸平均（18．6±2．3）Fr，手术时间15—45min，平均30min，术中平均出血量约为11．7ml，并发症发生率为22．2％（4／18），包括胆管炎3例，胰腺炎1例，经对症治疗缓解，无胆管穿孔、大出血等严重并发症，总结石清除率为64．7％（11／17），取石次数（3．3±2．6）次。结论从本组有限的病例资料结果来看，导丝两点牵引能够为经皮经肝窦道扩张提供确切的引导，是安全有效并且易行的，但仍需进一步扩大样本量来证实。

Objective To explore the feasibility and effectiveness of the two-point traction with guidewire method to improve the safety of percutaneous transhepatic sinus tract dilation. Methods The clinical data of 18 patients underwent the two-point traction guided by percutaneous transhepatic sinus dilation between January 2013 and July 2017 in Shengjing Hospital of China Medical University were analyzed retrospectively. The operation time, volume of intraoperative blood loss and postoperative complications were recorded. Results All of the 18 patients were treated successfully. The mean size of the percutaneous transhepatic sinus tract was （18.6 ＋ 2. 3 ） Fr. The operation time was 15 -45 min, with an average of 30 minutes, and the average intraoperative blood loss was about 11.7 ml. The incidence of postoperative complications was 22. 2% （4/18）, including cholangitis in 3 patients, pancreatitis in 1 case. All the complications were relieved after symptomatic treatment, no severe complications （biliary tract perforation or severe haemorrhage） occurred. A total of （3.3 -＋ 2. 6） times cholangioscopic explorations for stone extraction were performed,with a overall clearance rate of 64. 7% （ 11/17 ）. Conclusions From the results of limited patient data in this group, the two-point traction with guidewire can provide the exact guidance for percutaneous transhepatic sinus tract dilation, which is effective and easily conducted, but still need further clinical study to confirm.