超声引导下经皮经肝胆管置管引流术对恶性梗阻性黄疸的治疗效果

目的探讨超声引导下经皮经肝胆管置管引流术（PTCD）对恶性梗阻性黄疸患者的治疗效果。方法回顾分析我院2013年4月~2015年9月期间，超声引导下PTCD治疗的97例恶性梗阻性黄疸患者临床资料，观察分析治疗后并发症及其预后，同时比较治疗前后下述指标的变化：总胆红素、直接胆红素、胆汁酸、谷草转氨酶、谷丙氨酶、谷氨酰转肽酶、碱性磷酸酶、白蛋白、前白蛋白。结果97例患者均置管成功，成功率100%，PTCD术后患者恶心、呕吐、腹胀、皮肤瘙痒等症状明显改善，黄疸减轻。97例患者，术后出现2例胆道感染，发生率2.06%；1例急性胰腺炎，发生率1.03%；上述并发症经保守治疗后，2周内痊愈。PTCD治疗后总胆红素、直接胆红素、胆汁酸、谷草转氨酶、谷丙氨酶、谷氨酰转肽酶、碱性磷酸酶水平均显著下降，白蛋白、前白蛋白水平显著提高，均有统计学意义（P<0.05）。结论恶性梗阻性黄疸患者通过超声引导下实施PTCD治疗，不仅能够快速降低血清胆红素水平、促进黄疸消退、改善肝功能，而且具有实时准确、安全可靠等特点，疗效显著，应予推广。

Application of ultrasound guided percutaneous transhepatic cholangial drainage in the treatment of malignant obstructive jaundice

Objective To explore the therapeutic effect of ultrasound guided percutaneous biliary drainage in patients with malignant obstructive jaundice. Methods A total of 97 cases with malignant obstruction jaundice underwent percutaneous transhepatic cholangioma drainge (PTCD) using the guidance of ultrasound in our hospital since April 2013 to September 2015. All clinical data before PTCD were retrospectively compared with those after PTCD, including TBIL, DBIL, TBA, AST, ALT, GGT, ALP, ALB and PA. Postoperative complications and prognosis were also observed. Results All cases were performed PTCD using the guidance of ultrasound successfully. Nausea, vomiting, abdominal distension, loss of appetite, skin itching and jaundice significantly improved. In 97 cases, there were two cases of biliary tract infection（the incidence rate of 2.06%）and one case of acute pancreatitis(the incidence rate of 1.03%), which were cured with medicine. The levels of all the laboratory index including TBIL, DBIL, TBA, AST, ALT, GGT, ALP, ALB and PA after treatment were significantly improved in comparison with those levels before treatment (P<0.05). Conclusions PTCD using ultrasound guidance in patients with malignant obstructive jaundice can not only reduce the serum bilirubin level and improve liver function, but also has merits of accuracy, safety and reliability.