超声引导下经皮肝穿刺胆管引流术治疗阻塞性黄疸的临床价值

目的探讨超声引导下经皮经肝穿刺胆管引流术（PTCD）治疗阻塞性黄疸的临床应用价值。方法回顾性分析PTCD治疗149例阻塞性黄疸患者的成功率与并发症，其中胆管癌60例，胆管结石35例，胰头癌28例，手术后胆管狭窄8例，急性化脓性胆管炎6例，胆囊癌7例，壶腹周围癌3例，胰体癌2例。结果146例穿刺成功（146／149，97．99％），其中经肝左叶肝内胆管置管104例，经肝右叶肝内胆管置管34例，肝左叶及肝右叶肝内胆管均置管8例。3例穿刺失败，均为胆管癌（3／149，2．01％），其中2例因肝内胆管内径纤细、穿刺路径过深而无法成功植入引流管；1例因穿刺胆管持续出血而被迫终止手术。穿刺术后随访1周～18个月，除3例患者出现引流管脱出、1例胆管感染外，其余病例均引流通畅，无明显并发症。结论彩色多普勒超声引导下PTCD治疗阻塞性黄疸操作简便，安全、有效。

Value of ultrasound-guided percutaneous transhepatic cholangio drainage in the treatment of obstructive jaundice

Objective To observe the value of ultrasound-guided percutaneous transhepatic cholangio drainage (PTCD) in treatment of obstructive jaundice. Methods Totally 149 obstructive jaundice patients underwent PTCD under the guidance of color Doppler ultrasound, including 60 patients with biliary carcinoma, 35 with biliary stones, 28 with pancreatic head cancer, 8 with biliary narrow after operation, 6 with acute suppurative cholangitis, 7 with gallbladder carcinoma, 3 with perampullary adenocarcinoma and 2 with pancreatic body cancer. Complications and the success rate of PTCD were analyzed. Results The success rate of PTCD was 97.99% (146/149). Among 146 successful cases, 104 were carried out by pass through the biliary duct of the left lateral lobe, 34 through the right biliary duct, 8 through both right and left biliary ducts. PTCD was failed in 3 patients with biliary carcinoma (3/149, 2.01%), including 2 with too narrow biliary duct to puncture, 1 terminating operation due to continuing bile duct hemorrhage. The drainage-tubes performed well during follow-up for one week to 18 months, except 3 with tubes shed and 1 with biliary duct infection. No serious complications occurred. Conclusion PTCD under the guidance with color Doppler ultrasound is convenient, safe and effective for the treatment of obstructive jaundice.