三维超声引导下ptcd治疗恶性阻塞性黄疸的临床价值探讨.docVIP

三维超声引导下PTCD治疗恶性阻塞性黄疸的临床价值探讨 作者：彭莉晴，李明星， 邹庆伟 【摘要】 　　目的　探讨在三维超声引导下经皮肝胆管穿刺置管引流术对治疗恶性阻塞性黄疸的临床价值。方法回顾性分析35例恶性梗阻性黄疸病人在三维超声引导下行PTCD术的临床资料，对首次穿刺成功率，置管成功率，以及术前、术后两周的肝生化指标进行分析。结果35例患者共行36次PTCD，其中l例首次穿刺失败，首次穿刺成功率97.22％(35／36)；置管成功率100%；术后2周患者症状、体征均明显改善，表现为黄疸减轻，皮肤瘙痒缓解，情绪好转，食欲增加，血清总胆红素由术前的103.4~621.7μmol／L降至术后两周的22.6~201.2μmol／L，无严重并发症发生。结论三维超声下导向穿刺首次穿刺成功率和置管成功率高，术后并发症发生率低；对不宜手术的恶性阻塞性黄疸病人是较好的选择，值得临床推广应用。 【关键词】 三维超声；恶性梗阻性黄疸；经皮肝胆管穿刺置管引流 　　AbstractObjectiveTo probe into the clinical value of 3-D ultrasound-guided PTCD for malignant obstructive jaundice.MethodsThe clinical data of 35 cases of malignant obstructive jaundice treated by 3-D ultrasound-guided PTCD were retrospectively analyized.The first puncture success rate and intubation success rate as well as hepatic biochemical criterion preoperatively and 2 weeks postoperatively were analyzed.ResultsPTCD was performed 36 times in 35 cases.Of these,the first puncture failed in 1.The first puncture success rate was 97.22%(35/36)and the intubation success rate 100%.The symptoms and signs of the patients ameliorated significantly 2 weeks postoperatively,presenting with a reduction in jaundice,remission of cutaneous pruritus,emotional improvement,an increase in an appetite,a derease in serum total bilirubin from 103.4~621.7μmol/L preoperatively to 22.6~201.2μmol/L 2weeks postoperatively and no severe complications.ConclusionsThree-dimensional ultrasound-guided PTCD has high puncture and intubation success rates and a low incidence rate of postoperative complications.It is a better choice for patients with malignant obstructive jaunce unsuitable for operation and worth application and dissemination. 　　KEYWORDSthree-dimensional ultrasoundmalignant obstructive jaundicePTCD 　　临床部分晚期恶性肿瘤所致的阻塞性黄疸患者已无手术指征，如果不能将胆汁引流，患者将会因肝功能衰竭或其他并发症而危及生命。现采用在三维超声引导下经皮经肝胆管穿刺置管引流术(percutaneous transhepatic cholangiographic drainage,PTCD)，可使患者减轻黄疸症状，改善生活质量，延长生命。本文通过回顾性分析2007~2009年，我科对35例恶性梗阻性黄疸患者实施三维超声导向下的PTCD术，探讨其操作应用和临床价值。 　　1资料与方法 　　1.1一般资料 35例均为200