PTCD在诊治阻塞性黄疸中的应用及体会

对阻塞性黄疸病人,术前进行经皮肝穿刺胆道引流术(PTCD)能达到胆道减压,减轻全身黄疸的目的,为该类病人术前准备提供一项行之有效的方法。本文报告12例,其定位诊断符合率为100％,定性诊断符合率为75％,结合实践提出了进行PTCD的适应证选择和预防并发症的切实措施。     

超声引导结合X线透视下PTCD治疗阻塞性黄疸

目的探讨超声引导结合X线透视下PTCD的操作技术及其临床应用价值。方法51例阻塞性黄疸患者,40例为恶性阻塞性病变,11例为良性阻塞性病变,在超声引导结合X线透视下行PTCD术,穿刺右叶胆管44例,穿刺左叶胆管7例,并常规造影。结果穿刺成功率100%,未出现出血、胆汁性腹膜炎等并发症。术后1周胆红素平均下降75.2ummol/L。结论超声引导结合X线透视下PTCD是一种治疗阻塞性黄疸的有效方法,具有安全、简便、经济、并发症少的优点。     

不同途径胆汁再利用对恶性梗阻性黄疸患者营养状况的影响

目的探讨两种胆汁再利用方法的临床应用价值,并观察有无不良反应。方法选取恶性梗阻性黄疸行经皮肝穿刺胆道引流术(PTCD)患者,随机分为胆汁回输联合肠内营养(EN)组(A组39例)、胆汁口服联合EN组(B组36例)与对照组(C组38例),通过各项指标比较各组患者胃肠功能及营养状况。结果 A、B组患者营养状况明显高于C组,差异有统计学意义,P0.05;A、B两组患者各项指标差异无统计学意义,P0.05;三组患者胃肠功能差异均无统计学意义,P0.05。结论两种胆汁再利用联合EN均可改善患者营养状况,且作用相似。住院患者可以首选胆汁回输联合EN,而不能进行胆汁回输的患者,可以选择口服胆汁联合EN。     

B超引导经皮肝穿刺胆道引流治疗阻塞性黄疸80例

目的探讨B超引导经皮肝穿刺胆道引流术（percutaneous transhepatic cholangial drainage,PTCD）治疗阻塞性黄疸的临床价值。方法回顾性分析广州中医药大学第一附属医院2009年5月至2012年5月80例阻塞性黄疸病例采用PTCD治疗的临床资料,总结放置PTC管数、平均手术时间、术后24 h胆汁引流量,并对比分析手术前后血清总胆红素水平（TB）差异。结果 80例患者穿刺放置PTC管95根,留置时间为7~185（45±21）d。平均手术时间为（30±15）min,术后24 h胆汁引流量为（415±214）ml。术后1周TB均值（μmol/L）与术前相比明显下降,差异有统计学意义（116±56vs 354±150,t=17.030,P〈0.01）。术后2周TB降至（57±36）μmol/L,与术后1周TB相比,差异有统计学意义（t=10.621,P〈0.01）。发生胆汁漏及胆道出血并发症共2例（2.5%）。结论 B超引导PTCD术具有微创、安全的优点,是治疗阻塞性黄疸有效方法之一。     

超声引导PTCD在急性梗阻性化脓性胆管炎的应用价值

目的探讨急性梗阻性化脓性胆管炎的治疗方法,床旁急诊超声引导经皮肝穿刺胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)在该病中的应用价值。方法收集2011年5月至201 5年6月海南省农垦总医院63例急性梗阻性化脓性胆管炎病人的临床资料,回顾分析床旁急诊超声引导PTCD的治疗效果。结果超声引导PTCD成功率为100%;引流量为250~830 ml/d,平均为(530±68)ml/d;引流后血常规及肝功能检查结果显示,与术前比较,白细胞计数(WBC)、血清总胆红素(TBIL)、血清直接胆红素(DBIL)、丙氨酸转氨酶(ALT)指标显著下降,血小板计数(BPC)上升,体温正常,差异均有统计学意义(P0.01)。症状改善58例(92%),死亡5例(8%),无引流管脱落,无腹腔内出血、胆道出血、气胸、胆漏等并发症发生。结论床旁急诊超声引导PTCD,能快速有效引流,操作方便、简单,创伤小,并发症少,安全性高,能为解除病因手术安全性创造条件。     

Clinical features and treatment of hepatic abscesses with biloma formation after transcatheter arterial chemoembolization

Background and study aimsA full understanding of the clinical manifestations and risk factors for hepatic abscesses with biloma formation after transcatheter arterial chemoembolization (TACE) is crucial for accurate diagnosis and effective therapeutic intervention.Patients and methods11,524 patients with hepatic tumors were treated with TACE. 84 patients were diagnosed with hepatic abscesses after TACE, and 35 progressed to hepatic bilomas and were treated with percutaneous transhepatic drainage (PTD) and/or percutaneous transhepatic cholangiography and drainage (PTCD). Clinical features, blood samples, bacterial cultures, and imaging data were collected, and incidence, risk factors, therapeutic effects, and prognostic indicators were analyzed.ResultsThe incidence of biloma in patients with liver abscesses was 41.7% with an average diagnosis time of 12.3 ± 3.2 days. 71.4% of patients complained of abdominal pain, and 63.7% had metastatic liver cancer. In the latter patients, clinical features included multiple abscess lesions with a poor blood supply to the tumor and large necrotic lesions. The original tumors were primarily in the digestive system (87.0%). The mean diameter of the largest lesions was 6.5 ± 2.3 cm. Before abscess formation, the Child-Pugh liver function classification was grade A in 14 cases and grade B in 21 cases. Escherichia coli was the most frequently seen infectious bacteria. Liver function was significantly compromised by the occurrence of hepatic abscesses. The mean survival time after diagnosis of liver abscesses in all patients was 11.5 ± 0.6 months. The causes of death included abscess (n = 9, 25.7%), tumor (n = 22, 62.9%), and other causes (n = 4, 11.4%). Risk factors included tumors, gastrointestinal surgery, and diabetes.ConclusionPTD and/or PTCD combined with active antibiotics are recommended as the first-line treatment and are effective therapeutic regimens for biloma formation after TACE.     

恶性阻塞性黄疸患者经皮肝穿胆道内外引流术的观察与护理

恶性阻塞性黄疸是因各种消化道恶性肿瘤引起胆管的不同部位变狭窄或闭塞而致临床上产生相应症状的一组疾病,临床表现为全身皮肤及巩膜黄染、小便赤黄、大便陶土色改变及皮肤瘙痒等症状,一旦出现黄疸多属于肿瘤晚期,如不及时治疗将于短期内出现肝功能衰竭或肝肾综合征而死亡。我     

恶性梗阻性黄疸的介入治疗

目的:探讨经皮经肝穿刺胆管内外引流(PTCD)和金属内支架植入术治疗恶性梗阻性黄疸的价值。材料与方法:对32例恶性梗阻性黄疸患者采用经皮经肝穿刺胆管内外引流和金属内支架植入术。结果:32例手术均获成功,术后黄疸和皮肤瘙痒减轻,总胆红素明显下降,肝功能改善,并发症少,效果满意。结论:此方法创伤小,并发症少,操作简单,引流可靠有效,是晚期恶性梗阻性黄疸较好的引流方法。     

CT片指导穿刺点定位在PTCD中的应用（附116例分析）

本文根据116例梗阻性黄疽的CT图像分析了右肝管肝内水平段的分布位置。指出经皮肝穿刺胆道造影与引流术(PTCD)术前借助CT片定位将提高穿刺的命中率。     

超声引导下经皮肝穿胆道造影及胆管内置管引流在梗阻性黄疸中临床应用

本文报告１０例超声引导下经皮肝穿胆道造影，胆管内置管引流成功经验。１０例病人均为恶性梗阻性黄疸。成功９例，１例因肝内胆管畸形改变未成功。９例成功引流的病人均行手术治疗，术后无一例并发症。进行超声引导下行胆道造影，胆管内置管引流准确性及成功率高，明显减少术后并发症，是值得推广的一种方法。