三维超声引导下PTCD治疗恶性阻塞性黄疸的临床价值探讨

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1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,皮肤瘙瘁缓解,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.

The Clinical Value of 3-D Ultrasound-guided PTCD for Malignant Obstructive Jaundice

Objective To probe into the clinical value of 3 - D ultrasound - guided PTCD for malignant obstructive jaundice. Methods The 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. Results PTCD 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 significandy 2 weeks post- operatively, presenting with a reduction in jaundice, remission of cutaneous pruritus, emotional improvement, an increase in an appetite, a de- rease in serum total bilirubin from 103.4 ~ 621.7p, mol/L preoperatively to 22. 6 - 201.2txmol/L 2weeks postoperatively and no severe com- plications. Conclusions Three - 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 ap- plication and dissemination.