超声引导下经皮肝穿刺胆管引流术治疗肝硬化伴恶性梗阻性黄疸的应用价值

Ultrasound-guided percutaneous transhepatic cholangiography and drainage in the treatment of malignant obstructive jaundice with hepatic cirrhosis

目的探讨超声引导经皮肝穿刺胆管引流术(PTCD)在肝硬化伴恶性梗阻性黄疸患者治疗的方法和效果。方法超声引导下对88例肝硬化伴恶性梗阻性黄疸患者进行PTCD术,其中选择套管针法26例,Seldinger法28例,三步法34例,穿刺引流成功后将引流管置入患者扩张的胆管内并保留,比较各组穿刺方法及选择各种穿刺路径的的一次性穿刺成功率及治疗效果情况。结果 88例肝硬化伴恶性梗阻性黄疸患者的PTCD术中,套管针法、Seldinger法、三步法的一次性穿刺成功率分别为77%(20/26)、79%(22/28)、91%(31/34)。选择左外叶下段支、左外叶上段支、右前叶支、右后叶支胆管穿刺置管一次性穿刺成功率分别为89%(32/36)、75%(9/12),83%(25/30)、70%(7/10)。术后3～7 d 88例患者血清总胆红素和肝内胆管超声测值均较术前降低(P<0.05)。结论超声引导下PTCD是治疗肝硬化伴恶性梗阻性黄疸的有效方法,具有安全有效,并发症少的优点,三步法优于套管针法和Seldinger法,选择左外叶下段和右前叶支胆管穿刺成功率较高。

Objective To evaluate the clinical effect of ultrasound-guided percutaneous transhepatic cholangiography and drainag(PTCD)in treating malignant obstructive jaundice with hepatic cirrhosis,and to discuss its technical points.Methods Eighty-eight patients with hepatic cirrhosis accompanied malignant obstructive jaundice underwent PTCD under ultrasonic guidance.They were divided into three groups.Group A composed of 26 patients who received the trocar technique.Group B consisted 28 patients who were employed Seldinger's technique.Group C included 34 patients who received the three-step technique.Finally,tube were inserted to the target biliary duct in all cases.Compare the successful rates of once PTCD of three groups to evaluate the efficacy of post-palliative treatment.Results The successful rates of once PTCD for those receiving trocar technique,Seldinger′s technique and three-step technique were 77%(20/26)、79%(22/28)、91%(31/34),respectively.The successful rates of once centesis punctured hepatic duct of inferior segmental of the left lateral lobe、superior segmental of the left lateral lobe、right anterior lobe and right posterior lobe were 89%(32/36)、75%(9/12),83%(25/30)、70%(7/10),respectively.The manifestations of jaundice improved and the level of total serum bilirubin and The diameter of biliary ductdecreased gradually after PTCD.Conclusion Ultrasound-guided PTCD is an effective technique,which is safe and has little complication for treating patients with malignant obstructive jaundice of hepatic cirrhosis.Three-step technique of PTCD is more effective compared with trocar technique and Seldinger's technique.The success rate of hepatic duct of inferior segmental of the left lateral lobe and right anterior lobe for PTCD is higher.