探讨超声引导下经皮肝胆管穿刺引流术治疗梗阻性黄疸的临床应用价值及经验交流

The clinical application value of ultrasound-guided percutaneous transhepatic cholangial drainage in the treatment of obstructive jaundice and exchange of experience

目的实时常规超声引导下行经皮肝胆管穿刺引流术(PTCD)治疗梗阻性黄疸(Obstructive jaundice,OJ)的临床应用价值及临床经验交流.方法回顾性分析2018年6月—2021年4月皖南医学院第一附属医院弋矶山医院收治的133例梗阻性黄疸住院患者临床资料,其中恶性阻塞性病变118例,良性阻塞性病变15例,数据完整、纳入研究为85例(胰腺、壶腹部占位伴梗阻11例;肝脏原发性占位、转移灶伴梗阻23例,胆管系统恶性病变伴梗阻48例,其中1例合并胆管多发结石;单纯的肝内胆管系统结石合并感染、梗阻的患者有3例),在超声引导下行PTCD术,术后随访常规肝功能实验室检查及并发症.结果纳入研究的85例患者,在介入超声医师与临床医生合作下共行PTCD术86例次,84例患者1次性置管成功,成功率为97.67%(84/86).选择左、右胆管穿刺分别为32例、53例.术后并发症共有16例,其中引流管脱落、胆管少量出血、腹腔出血、胆管感染分别为5例、7例、1例、3例.术后梗阻性黄疸症状逐渐改善,血清总胆红素前明显下降、肝功能总体较术前好转,且差异具有统计学意义(P<0.05).数据统计选择左、右胆管引流对肝功能影响无明显差异(P>0.05).结论实时常规超声引导下PTCD治疗OJ患者的黄疸能有效减轻,肝功能不同程度改善;简便、微创、疗效确切等优点.

Objective To explore the clinical application value of real-time routine ultrasound-guided percutaneous transhepatic cholangial drainage(PTCD)in treating obstructive jaundice(OJ)and exchange of clinical experience.Methods Retrospectively analyze the clinical data of 133 inpatients those were admitted to Yijishan hospital,the first affiliated hospital of Wannan Medical College from June 2018 to April 2021 due to obstructive jaundice,including 118 cases of malignant obstructive lesions and 15 cases of benign obstructive lesions.85 cases with complete data were included in the study(11 cases of pancreas,and ampulla was occupied complicated with obstruction;23 cases of liver primary mass and metastases lesions with obstruction,the biliary system malignant lesions with obstruction occurred in 48 cases,which including one case with multiple bile duct stones;3 patients with single intrahepatic biliary system stones combined with infection and obstruction),patients underwent ultrasound-guided PTCD and were followed up for laboratory tests of routine postoperative liver function and complications.Results Among the 85 patients included in the study,a total of 86 PTCD procedures were performed under the cooperation of the interventional sonographer and the clinician.84 patients had a successful one-time placement,with a success rate of 97.67%(84/86).There were 32 and 53 cases received bile duct punctures on the left and right side,respectively.There were 16 cases of postoperative complications,of which 5 cases of drainage tube dislodgement,7 cases of small amount of bile duct bleeding,1 case of abdominal bleeding and 3 cases of biliary tract infection.After the operation,the symptoms of obstructive jaundice gradually improved,the total serum bilirubin decreased significantly,and the overall liver function improved compared with that before the operation,and the differences were statistically significant.Statistical analysis indicated that left or right bile duct drainage had no significant difference in the effect on liver function.Conclusions Real-time conventional ultrasound-guided PTCD for treating OJ patients could effectively reduce jaundice and improve liver function to varying degrees;it is simple,minimally invasive and has the advantages of precise efficacy.