MRI三维重建在PTCD定位的应用

Application of MR three-dimensional reconstruction in the localization of PTCD

目的探讨对肝内胆管经皮肝穿刺胆道引流术(percutaneous transhepatic cholongial drainage,PTCD)中MRI三维重建技术的应用价值。方法选取我院60例行肝管穿刺引流术的梗阻性黄疸患者为观察对象,观察组采用MRI三维重建进行引导穿刺,对照组采用传统的DSA引导下穿刺,每组30例。对比穿刺次数、两组手术时间、完成置管DSA显示X线剂量、并发症发生率、手术成功率。结果观察组穿刺次数[(1.8±0.6)次vs对照组(3.0±1.1)次,P<0.05]、手术时间[(22.8±4.8)min vs(38.8±7.6)min,P<0.05]短于对照组,完成置管DSA显示X线剂量[(164.5±54.6)mGy vs(810.7±410.7)mGy,P<0.05]少于对照组。观察组并发症发生率3.3%低于对照组26.7%。观察组30例全部成功完成置管引流术,手术成功率100%;对照组25例完成置管引流术,手术成功率83.3%。两组手术成功率比较差异有统计学意义(P<0.05)。结论在肝管穿刺引流术中采取MRI三维重建技术,不仅具有较高的安全性,且能够有效缩短介入治疗时间,穿刺次数也随之相应的减少,手术的成功率更高,降低手术并发症,提高患者对于手术的耐受性。

Objective To investigate the application value of MRI three-dimensional reconstruction in percutaneous transhepatic cholongial drainage of intrahepatic bile duct.Methods 60 patients with obstructive jaundice who underwent hepatic duct puncture and drainage were selected as the observation objects.The observation group was guided by MRI three-dimensional reconstruction,and the control group was guided by traditional DSA,with 30 cases in each group.The puncture times,operation time,X-ray dose,complication rate and operation success rate were compared between the two groups.Results The puncture times of the observation group(1.8±6)times vs(3.00±1)times,P<0.01,or operation time(22.81±4.8)min vs(38.8±6)min,P<0.01 was shorter than that of the control group,and the X-ray dose of DSA was(164±54.6)mGy vs(810.7±7)mGy,P<0.01 that was less than that of the control group.The incidence of complications in the observation group 3.3%(1/30)was lower than that in the control group 26.7%(8/30).In the observation group,all 30 cases were successfully treated with catheter drainage,and the success rate of operation was 100%;In control group,the success rate was 83.3%.There was significant difference in the success rate between the two groups(P<0.05).Conclusion MRI three-dimensional reconstruction technology in liver tube puncture and drainage not only has high safety,but also can effectively shorten the treatment time,the number of puncture are also reduced,the success rate of operation is higher.It can reduce the complications of operation,and improve the tolerance of patients for operation.