经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸并发症分析

目的探讨经皮肝穿刺胆道造影与引流术(percutaneous transhepatic biliary drainage,PTBD)治疗恶性梗阻性黄疸(malignant obstruction jaundice,MOJ)并发症发生的原因及预防措施。方法复习311例PTBD治疗MOJ的住院病史,统计并发症种类与病例数,分析并发症的发生原因,探讨相关的预防措施。结果PTBD治疗MOJ 311例,共发生各种并发症165例(53.1%),其中胆道感染46例(14.8%),引流管移位38例(12.2%),引流管堵塞31例(10%),瘘口渗漏20例(6.4%),瘘口皮肤感染18例(5.8%),胆道出血6例(1.9%),胆汁性腹膜炎2例(0.6%),胆汁引流过多2例(0.6%),肝脓肿1例(0.3%),气胸1例(0.3%)。结论PTBD治疗MOJ具有较高的并发症发生风险,严格掌握PTBD适应证和禁忌证,及时处理引流管相关问题,可减少和控制严重PTBD并发症的发生。

To assess the complications of percutaneous transhepatic biliary drainage for malignant obstructive jaundice

Objective To assess the reason and prevention methods of the complications using percutaneous transhepatic biliary drainage(PTBD) for malignant obstructive jaundice(MOJ).Methods The medical record of 311 patients who underwent PTBD for MOJ was reviewed with attention to the complications resulting from this mode of drainage and assessment the prevention methods.Results One hundred and sixty-five cases occurred in various complications in all patients who underwent PTBD.The incidence of the complication was 53.1% in this group.Observed was a higher incidence of complications of infectious of biliary tract(14.8%),drainage dislodgement(12.2%) and tube emphraxis(10%) than the others(P<0.05).Conclusion PTBD carries a high risk of complications in patients with MOJ.The severe complications maybe avoid by obeying the indications and counterindication and handling the problem related to drainage tube at first time.