PTBD治疗肝内胆管微扩张型梗阻性黄疸.docVIP

PTBD治疗肝内胆管微扩张型梗阻性黄疸【摘要】 目的 探讨超声实时引导结合X线透视下,经皮肝胆管穿刺置管引流术(PTBD)治疗肝内胆管微扩张型梗阻性黄疸的操作技术及其临床应用价值。方法 回顾性分析9例肝内胆管微扩张型梗阻性黄疸患者的临床资料,6例行右肝胆管PTBD,3例行左肝胆管PTBD。结果 胆管穿刺置管成功率100%,术后短暂性发热1例、一过性血性胆汁1例,未出现腹腔出血及胆汁性腹膜炎等严重并发症,术后一周胆红素平均下降(75.4±29.6)μmol/L。引流时间10 d~5个月。结论 超声引导结合X线透视下PTBD治疗肝内胆管微扩张型梗阻性黄疸是安全可行的。 【关键词】 超声;X线透视;梗阻性黄疸;经皮肝胆管穿刺置管引流术(PTBD) The use of PTBD in patients with obstructive jaundice with nondilated intrahepatic bile ducts ZHAO Zhiming,YU Dejiang,JI Wenbin,et al.Department of Hepatobiliary Surgery,Chinese PLA Jeneral Hospital,Beijing 100853,China 【Abstract】 Objective To investigate the technical and clinical value of PTBD in patients with obstructive jaundice with nondilated intrahepatic bile ducts by the guiding of ultrasound combined with Xray scan.Methods PTBD was performed in 9 patients with with nondilated intrahepatic bile ducts,guided by combining ultrasound and Xray scan.6 patients were punctured to right bile ducts and 3 were left bile ducts.Results Technical success was obtained in all patients.There were only two minor complications:transient hemobilia(n=1)and fever(n=1).No hemorrhage and biliary peritonitis were found after procedures.The bilirubin was reduced by75.4±29.6ummol/L one week later.Conclusion Ultrasoundandfluoroscopy guided PTBD in patients with nondilated bile ducts is a safe,feasible,and efficient procedure for the palliation of biliary obstruction. 【Key words】 Ultrasound;Xray scan;Obstructive jaundice;Percutaneous transhepatic biliary drainage(PTBD) 经皮肝胆管穿刺置管引流术(PTBD)是一种针对梗阻性黄疸患者术前减黄和姑息性治疗的有效方法。近年来,由于高分辨率超声仪器的使用和导管技术的改进,肝内胆管内径6 mm者,超声实时引导下的PTBD成功率较高。但是对于肝内胆管内径均5 mm的梗阻性黄疸患者,行PTBD则较为困难。近年来,笔者在超声实时引导下,结合X线透视对9例胆管扩张仅为3~5 mm左右、且ERCP较困难的梗阻性黄疸患者行PTBD,并取得了成功。现汇报如下,旨在探讨其操作技术改进及临床应用价值。 1 资料与方法 1.1 一般资料 2006年1月至2009年1月,在我院行超声引导结合X 线透视下PTBD治疗肝内胆管微扩张型梗阻性黄疸患者9例,其中男5例,女4例;年龄37~71岁,中位数52岁;肝内左右肝管同时扩张5例,单纯右肝管扩张1例,单纯左肝管扩张3例;扩张胆管内径均3.6~5.4 mm,平均(4.3±1.5)mm。9例患者中,2例为肝移植术后缺血性胆道病,2例为胆肠吻合术后吻合口狭窄伴胆管炎,2例为肝门部胆管癌单侧PTBD术后伴对侧肝内节段性胆管炎,2例为肝内胆管细胞癌,1例