经皮肝胆囊穿刺在治疗胆道梗阻中的应用

目的：探讨经皮肝胆囊穿刺（PTGD）在急性胰腺炎伴胆道梗阻患者解除梗阻中的应用价值。方法：选择伴有胆道梗阻的55例急性胰腺炎患者，根据治疗方法不同分为：PTGD组（27例）和内镜治疗组（28例）。比较两组患者预后、并发症和解除胆道梗阻疗效间的差异。结果：55例患者中28例先行PTGD治疗，其中3例治疗失败后改为内镜引流；27例先行内镜引流治疗，2例失败后改PTGD治疗。30例接受PTGD治疗的患者中，27例（90．0％）置管成功；30例接受内镜治疗的患者28例（93．3％）引流成功。PTGD组和内镜治疗组的梗阻解除率分别为92．6％和92．9％，两组间比较差异无显著性意义（P〉0．05），但内镜治疗组的胆红素下降明显快于PTGD组（P〈0．05）．．PTGD组有1例发生胆瘘，1例穿刺管脱出胆囊，但PTGD组腹胀痛和肺损伤等并发症明显低于内镜治疗组（P〈0．01）。两组患者急性期并发症、胰周感染率和治愈率等差异无显著性意义（P〉0．05）。结论：PTGD是一种解除胰腺炎患者胆道梗阻安全有效的方法。

Application of percutaneous transhepatic gallbladder drainage for the treatment of acute pancreatitis with the biliary obstruction

Objective: To evaluate the effect of ultrasound guided percutaneous transhepatic gallbladder drainage(PTGD) for the treatment of acute pancreatitis(AP) with the biliary obstruction.Methods:Twenty eight of 55 cases of AP with biliary obstruction from 2001 to 2003 received PTGD,and 3 cases received endoscopy treatment instead after PTGD had failed;27 cased received endoscopics treatment at first,and 2 cases who failed to apply PTGD.The rapidity of jaundice's fading away,complications of the operation and outcome of patients were measured in two groups. Results:PTGD was successfully performed in 27 patients(90%),and endoscopics treatment in 28 patients(93.3%).The rate of biliary obstruction's abatement was 92.6% in PTGD and 92.9% in endoscopics group(P>0.05).Compared with the PTGD,the rapidity of jaundice's fadeaway was more significant swiftness in endoscopics group(P<0.05).In PTGD group,bile leakage occurred in 1 patient,and downfall of drainage occurred in 1 case.The complications of bellyache and lung injury was less in PTGD than these in endoscopics group(P<0.01).The rate of complication in first period of AP,infection around pancreas,and prognosis of the disease were no significant difference in two groups(P>0.05). Conclusion: PTGD was a safe and effective procedure for the treatment of AP with the biliary obstruction.