超声引导下PTCD与ERCP对接治疗恶性胆道梗阻

目的探讨内镜逆行胰胆管造影术（ERCP）联合超声引导下经皮肝穿刺胆道放置导丝（PTC）治疗难治性恶性胆道梗阻的技术特点和临床效果。方法对18例胆道恶性梗阻ERCP治疗失败患者,先超声引导下PTC放置导丝入十二指肠,ERCP时经过此导丝行奥迪氏括约肌行胆道支架置入术,并观察其临床效果。结果 18例均获得成功,其中右侧肝管穿刺12例,左侧肝管6例,主要并发症为胆道感染,7天后查血胆红素均明显下降。结论 PTCD与ERCP对接术是治疗ERCP失败的恶性梗阻性黄疸的另一新方法,具有良好的临床应用价值,但是对技术要求比较高,要严格把握其适应症。

PTCD and ERCP butt joint guided by ultrasound in treating malignant obstructive jaundice

Objective To study the technical features and clinical value of Percutaneous transhepatic biliary drainage （PTCD） and Endoscopic Retrograde Cholangiography Pancreas （ERCP） ERCP butt joint guided by ultrasound in treating malignant obstructive jaundice. Methods Totally 18 cases of malignant biliary obstruction patients those who were failed in previous treatment were included in this study, the wire was placed into the duodenum first under the supersonic guidance, and biliary duct support was implanted through this wire when executing ERCP, its clinical effect was observed. Results All operations were succeed. According to the PTCD drainage approach, 12 cases were from right side, and 6 from left side. The main complication was bile duct infection. The hemobilirubin of 18 malignancy obstruction jaundice patients obviously dropped seven days after the operation. Conclusions PTCD and ERCP butt joint is a new method while ERCP failed in the treatment of obstructive jaundice. This method has good clinical value, but it depends on the high technique, and we must grasp its indication strictly.