剑突下穿刺胆管造影响术

目的 报告剑突下穿刺胆管造影术的临床应用经验。方法 在Ｂ超定位下于剑突下穿左肝管行ＰＴＣ检查,拔针后压迫穿刺点５～１０分钟。结果 ８６例行剑突下穿刺胆管造影术,７５例穿刺成功,成功率８７．２１％,手术证实无出血及胆漏并发症;１１例中转右侧径路ＰＴＣ或经皮肝穿刺胆囊造影术,中转率１２．７９％,其中１０例成功,术中发现不同程度出血和胆漏。总成功率９８．８４％。结论 剑突下穿刺胆管造影术可作为ＰＴＣ的首     

经皮肝穿胆道造影术靶胆管定位穿刺方法的临床应用

目的测定肝内扩张胆管位置,设计恰当的穿刺途径,提高经皮肝穿胆道造影术(PTC)成功率。方法对9例恶性阻塞性黄疸患者采用经皮肝穿靶胆管定位方法穿刺。结果穿刺次数为l～4次,共17次,每例平均1.9次,成功率为52.9%。结论经皮肝穿胆道造影术靶胆管定位穿刺可提高穿刺成功率,减少肝脏损伤等并发症。     

经皮肝穿刺胆道造影150例分析

目的：总结经皮肝穿刺胆道造影（PTC）的应用体会。材料与方法：回顾分析1988年1月～1997年12月收治的150例黄疸病人的临床资料和造影方法等。结果：本组PTC成功率为96％,诊断符合率达95％。结论：PTC在有经验的操作者手里是一项相当安全、有效的胆系疾病检查方法之一。     

DSA下经皮肝穿刺胆管引流及胆管支架置入术的护理体会

目的 探讨经皮经肝穿刺胆管引流(PTCD)及胆管支架置入术的护理.方法 对36例行PTCD配合胆管支架置入术患者做好术前准备、术中配合及针对性护理.结果 36例患者均成功进行了PTCD及胆管支架置入术,无护理并发症发生;术后1周复查血胆红素明显下降,皮肤瘙痒消失.结论 认真细致的术前及术中护理,是保证患者顺利度过手术期并达到预期治疗效果的有力保障.     

超声引导下经皮经肝穿刺胆管引流的临床应用

目的 探讨超声引导经皮经肝穿刺胆管引流(UPTCD)的临床应用价值。方法 应用ATL3000型彩色超声诊断仪引导下对30例梗阻性黄疽作经皮经肝胆管置管引流。结果 超声引导经皮经肝穿刺胆管内置管引流，一次成功率达83．3％，二次成功率达96．7％，三次成功率达100％。结论 超声引导下经皮经肝穿刺胆管内置管引流是一种微创、准确、安全、有效、简便的治疗梗阻性黄疽的方法；超声应成为PTDC术的首选引导方法。     

经皮肝穿刺胆管引流术联合调强放疗治疗恶性梗阻性黄疸的临床研究

目的 观察经皮肝胆管穿刺引流术（PTCD）联合调强放疗（IMRT）治疗恶性梗阻性黄疸（MOJ）的疗效.方法 采用TCD联合IMRT治疗MOJ对照既往实施常规PTCD的患者,观察并比较二者疗效.结果 观察组36例血清总胆红素（T-BiL）在PTCD治疗后1周明显下降,IMRT治疗结束1个月后持续下降;经IMRT治疗后肿瘤总有效率72.22％;PTCD联合IMRT组6个月、1年、2年累积生存率分别是77.78％、55.56％和11.11％,明显高于既往单纯行PTCD的生存率（57.14％、23.81％、0％）（P＜0.05）.2组的中位生存时间分别为18个月和9.2个月（P＜0.05）.结论 PTCD联合IMRT治疗MOJ安全有效,明显缓解黄疸和疼痛症状,从而提高患者的生活质量.     

内镜逆行胰胆管造影术与经皮肝穿刺胆道引流术治疗肝外胆管梗阻性黄疸的对比研究

目的探讨内镜逆行胰胆管造影术(ERCP)与经皮肝穿刺胆道引流术(PTCD)在治疗良、恶性肝外胆管梗阻性黄疸方面各自的优劣。方法回顾性分析2013年5月至2014年7月期间兰州大学第二医院普外四科收治的肝外胆管梗阻性黄疸患者并分别采用ERCP与PTCD治疗的临床资料,比较2种方法的手术成功率、5 d血清胆红素下降水平及术后常见并发症的发生率等。结果与PTCD相比,ERCP在治疗良性肝外胆管梗阻性黄疸时,术后5 d血清总胆红素水平下降速度较快[(94.9±11.58)μmol/L vs.(84.3±15.50)μmol/L,t=2.946,P=0.005],术后并发症发生率较低(3.3%vs.21.4%,χ2=4.469,P=0.035),但手术成功率(96.7%vs.92.9%,χ2=0.429,P=0.513)二者无统计学差异。在治疗恶性肝外胆管梗阻性黄疸时,两种方法术后常见并发症的发生率(9.5%vs.18.5%,χ2=0.767,P=0.381)虽无明显差异,但相比ERCP,在手术成功率(95.2%vs.70.4%,χ2=4.795,P=0.029)和术后5 d血清总胆红素水平下降速度[(206.3±13.26)μmol/L vs.(186.8±20.59)μmol/L,t=-2.516,P=0.015]方面PTCD组效果较为显著。结论对于良性肝外胆管梗阻性黄疸患者ERCP不仅具有创伤小、并发症少、起效快、疗效好的优点,而且可以从根本上解除梗阻;而对于恶性肝外胆管梗阻性黄疸,由于PTCD手术成功率高,可以有效缓解梗阻症状,快速降低血清胆红素水平,改善肝功能,提高患者生活质量,因此成为首选方法。     

恶性梗阻性黄疸行经皮肝穿刺胆管引流联合胆管支架置入患者的中西医结合护理

目的探讨对恶性梗阻性黄疸行经皮肝穿刺胆管引流(percutaneous transhepatic cholangial drainage,PTCD)联合胆管支架置入术患者实施中西医结合护理干预的效果。方法对102例恶性梗阻性黄疸行PTCD联合胆管支架置入术患者实施中西医结合护理干预措施,并观察临床效果。结果所有患者黄疸均明显好转,复查胆汁培养阴性,顺利出院。结论中西医结合护理干预有助于降低恶性梗阻性黄疸行PTCD患者术后并发症,提高治疗效果,促进康复过程。     

胆管癌栓经皮肝穿刺胆管造影术的诊断价值

目的：分析胆管癌栓经皮肝穿刺胆管造影术（Percutaneous transhepatic cholangiography，PTC）的影像特点，以提高胆管癌栓的诊断水平。资料与方法：回顾性分析27例经病理或临床证实为胆管癌栓的PTC图像特点。患者年龄（49.81±7.27）岁。27例患者均在超声或DSA引导下选择单侧或双侧穿刺入路行PTC，留置内引流管或外引流管，引流3~5 d后复查PTC以观察影像变化情况。结果：27例胆管癌栓均于胆管腔内可见充盈缺损影，26例充盈缺损及相应水平胆管呈“膨胀性”改变。24例癌栓近端胆管呈软藤样扩张，3例呈枯树枝样改变，癌栓远端胆管均无扩张。9例充盈缺损的轮廓完全显示，其余18例部分显示。21例引流前后所见充盈缺损范围基本一致，6例引流后充盈缺损范围较前缩小。根据其累及范围分为3型：Ⅰ型2例，Ⅱ型22例，Ⅲ型3例。结论：胆管癌栓有特异性的PTC表现，PTC对胆管癌栓的诊断有重要价值。     

经皮肝穿刺造影术的护理

经皮肝穿刺胆道造影(简称ＰＴＣ)和经皮肝穿刺胆道造影并引流(简称ＰＴＣＤ),是一种非排泄性胆道造影术,不受肝功能好坏特别是黄疸深浅程度的影响。显影较静脉造影清楚,可以确诊胆道梗阻的部位,推理梗阻的性质,但它又是一种损伤性的造影方法。造影后可能并发出血、胆漏及胆道感染。其成功与否,取决于肝内胆管扩张的程度,如扩张不明显,不易成功。近年来,随着穿刺针及穿刺方法的改进,术后并发症大为减少,成功率有显著提高,目前已成为黄疸鉴别诊断的重要方法之一。我院1996～1998年应用乙烯套管针,并在电视屏装置辅助操作下,共进行了30例造影术…     

B型超声引导经皮肝穿刺胆管造影的应用研究

应用B型超声（简称B超）引导经皮肝穿刺胆道造影（简称造影），对B超未能明确梗阻部位和病因的23例黄疸患者进行了检查。21例成功。结果表明：本方法除可确诊梗阻的具体位置外，还可依据造影后胆管阻塞端之影像特点判定梗阻的病因，为临床选择治疗方案提供可靠的依据。     

Experience with percutaneous transhepatic cholangiography using the Japanese needle

Percutaneous transhepatic cholangiography using a very thin needle has been performed in 885 patients with a variety of underlying hepatic, biliary, and pancreatic disorders. The procedure was successful in 99% of the patients with dilated intrahepatic bile ducts and in 85% of those with non-dilated ducts. Complications which required surgical intervention occurred only in two cases (0.2%). In patients with obstructive jaundice, external bile drainage was performed immediately after visualization of the bile duct. Percutaneous transhepatic cholangiography is an extremely useful and safe method for investigating disorders of the biliary tract, for localizing the cause of obstructive jaundice, and for reducing the degree of jaundice and improving the general status of patients with obstructive jaundice.     

Sclerosing cholangitis: Broad spectrum of radiographic features

The broad spectrum of radiographic appearance of sclerosing cholangitis is illustrated in 19 cases. A classification of intrahepatic and extrahepatic features is presented, based on extent of narrowing of bile ducts, severity of narrowing, contour abnormalities, and presence of postsclerotic dilatation. In 13 of 19 cases, both intra- and extrahepatic ducts were involved. The most common form of intrahepatic involvement (8/19) was irregular stenosis obliterating peripheral ducts leaving only the more central ducts filled with contrast material. The most common type of extrahepatic duct involvement was a well-defined segment of either smooth or irregular narrowing. The most extensive involvement of intrahepatic ducts was often associated with more well-defined, less extensive extrahepatic duct involvement. In 7 patients, radiographic features were evaluated over periods ranging from several months to several years. Intrahepatic duct involvement either remained unchanged or worsened, while extrahepatic features more often remained unchanged. Our classification of patterns of involvement was applied to previous reports and revealed frequency of type of duct involvement similar to our series.     

Obstructive jaundice in the absence of sonographic biliary dilatation

Four patients evaluated for obstructive jaundice had an ultrasonic examination without evidence of biliary dilatation. Subsequent percutaneous transhepatic cholangiographic examinations demonstrated an obstructive etiology without dilatation of the biliary system. Findings in these patients emphasize that the absence of sonographic biliary dilatation does not exclude the diagnosis of obstructive jaundice.     

梗阻性黄疸患者MRCP及肝胆断层MR检查对于PTC及PTBD指导作用的分析

目的比较MRCP与PTC在梗阻性黄疸的诊断过程中的优缺点,探讨MRCP对PTC和PTBD治疗的指导作用.方法 15例梗阻性黄疸患者分别进行MRCP和PTC检查,并行PTBD介入治疗,分析图像,对两种检查方法的定位、定性诊断的正确率和对胆道显示的情况进行比较.结果 MRCP与PTC的定位诊断和定性诊断的正确率分别为:PTC 100%和80%;MRCP 100%和93%.MRCP与PTC相比在梗阻性黄疸患者中能够更好地显示肝内外胆道的情况.与MRCP检查同时进行的横断面和冠状断层图像可以准确显示胆道管腔以外的病变.在MRCP指导下,PTBD介入治疗留置引流管单纯外引流6例,内外引流9例.引流效果满意,没有严重并发症发生.结论梗阻性黄疸患者的MRCP及肝胆断层MRI检查,可以较PTC提供更多的诊断信息,并对PTBD提供有力的指导作用,减少并发症,提高手术成功率.     

Obstructive jaundice as a long-term complication in a patient with liver transplantation

Obstructive jaundice related to stricture and stone in cystic duct was found in a patient 6 years after liver transplantation and cholecystojejunostomy. Complications with biliary drainage following liver transplantation are discussed. In the presence of dilated ducts seen by ultrasound, percutaneous transhepatic cholangiography performed immediately can lead to surgical correction, thus preventing failure of the liver transplant.The opinions or assertions contained herein are the private views of the author(s) and are not to be construed as official or as reflecting the views of the Department of the Army or of the Department of Defense     

PTC与B超在胆石症诊断中的价值比较

目的 对ＰＴＣ、Ｂ超在胆石症诊断中的价值进行比较。方法 对８４例做ＰＴＣ及Ｂ超两项检查的胆石症病人,按结石不同部位将检查结果与术后结果进行对照。结果 ＰＴＣ在胆管结石诊断中准确性较Ｂ超为高,而Ｂ超在胆囊结石诊断准确性方面较ＰＴＣ为高。在多部位结石诊断方面。两者差别不大。结论 ＰＴＣ与Ｂ超在胆石症诊断上各有所长。联合应用,将极大地提高诊断准确率。     

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。     

Diffuse intrahepatic bile duct abscesses — Diagnosed by percutaneous transhepatic cholangiography

Multiple intrahepatic abscesses are associated with a very high mortality rate. We believe that percutaneous transhepatic cholangiography (PTC) is the definitive diagnostic procedure in this condition. Two patients with biliary duct obstruction who developed hepatic abscesses are presented. The value of early diagnosis by PTC is stressed.