CT引导下一步法经皮肝穿刺胆管引流术治疗梗阻性黄疸患者疗效观察

CT-guided one-step percutaneous transhepatic cholangial drainage in the treatment of patients with malignant obstructive jaundice

目的观察在CT引导下采用一步法经皮肝穿刺胆管引流术(PTCD)治疗梗阻性黄疸患者的疗效。方法2017年1月~2019年12月我院收治的恶性梗阻性黄疸患者60例,随机分为对照组和观察组,每组30例,分别采用在X线透视引导下或在CT引导下一步法行PTCD穿刺置管引流治疗。结果术中,观察组穿刺一次性成功率为96.7%,显著高于对照组的43.3%(P<0.05),穿刺透视时间为(13.6±2.1)s,显著短于对照组【(32.6±4.1)s,P<0.05】,总穿刺时间为(48.9±10.3)s,显著短于对照组【(92.3±13.6)s,P<0.05】,辐射暴露剂量为(2.5±0.3)mGy,显著小于对照组【(5.8±1.1)mGy,P<0.05】;在术后2 w时,观察组血清总胆红素水平由(241.8±83.6)μmol/L降至(109.8±45.6)μmol/L,对照组由(242.4±91.2)μmol/L降至(108.4±61.9)μmol/L,两组肝功能指标变化无显著性差异(P>0.05);在术后3月末,观察组胆道感染、出血、肝脓肿和腹膜炎发生率为3.3%,显著低于对照组的26.6%(P<0.05)。结论在CT引导下采取一步法PTCD术治疗恶性梗阻性黄疸患者可提高穿刺效率,减少术后并发症发生率,具有较好的临床应用价值。

Objective The aim of this study was to observe the curative effect of CT-guided one-step percutaneous transhepatic cholangial drainage(PTCD)in the treatment of patients with malignant obstructive jaundice(MOJ).Methods 60 patients with MOJ were enrolled in our hospital between January 2017 and December 2019,and they were divided randomly into control(n=30)and observation group(n=30).The patients were given PTCD under the guidance of X-ray fluoroscopy in the control or CT-guided one-step puncture in the observation.Results During the operation,the one-time success rate of puncture in the observation group was significantly higher than that in the control group(96.7%vs.43.3%,P<0.05),the fluoroscopy time was significantly shorter than that in the control group[(13.6±2.1)s vs.(32.6±4.1)s,P<0.05],the total puncture time was significantly shorter than that in the control group[(48.9±10.3)s vs.(92.3±13.6)s,P<0.05],and the radiation exposure dose was significantly less than that in the control group[(2.5±0.3)mGy vs.(5.8±1.1)mGy,P<0.05];at the end of two weeks after the surgery,total serum bilirubin level in the observation group decreased from(241.8±83.6)μmol/L to(109.8±45.6)μmol/L,that in the control decreased from(242.4±91.2)μmol/L to(108.4±61.9)μmol/L,and there were no significant differences respect to other liver function tests between the two groups(P>0.05);at the end of three month,the post-operational complications such as biliary infection,bleeding,liver abscess and peritonitis in the observation was 3.3%,significantly lower than 26.6%in the control(P<0.05).Conclusion CT-guided one-step PTCD in dealing with patient with malignant obstructive jaundice could improve the puncture successfully,which might be applied in clinical practice overwhelmingly.