超声引导与数字减影血管造影引导在经皮肝胆道镜治疗肝胆管结石术前建立通道的比较研究.docVIP

超声引导与数字减影血管造影引导在经皮肝胆道镜治疗肝胆管结石术前建立通道的比较研究 　　[摘要] 目的 比较两种不同穿刺方法在经皮肝胆道镜治疗肝胆管结石术前建立通道中的应用效果。 方法 回顾分析2014年4月～2015年10月东莞市第五人民医院收治的38例肝胆管结石患者的临床资料，20例超声引导经皮肝胆道引流术（PTCD）建立术前取石通道为A组，18例数字减影血管造影（DSA）引导PTCD建立术前取石通道为B组。对两组不同影像引导方法的胆管穿刺准确性、总穿刺时间、PTCD置管成功率、置管术时间、介入医师及患者受X线辐射剂量、穿刺路径合理性、并发症发生率、结石取净率等指标进行比较分析。 结果 A组在胆管穿刺准确性、总穿刺时间、并发症发生率、介入医师及患者受X线辐射暴露剂量方面优于B组，差异有统计学意义（P 0.05）；B组在PTCD置管成功率、置管术时间、穿刺路径合理性、结石取净率方面优于A组，差异有统计学意义（P 0.05）。 结论 在经皮肝胆道镜治疗肝胆管结石术前建立通道中，超声与DSA两种引导方法各有优缺点。两者相互配合使用可使经皮肝胆道镜（PTCs）术通道建立更安全、高效。 　　[关键词] 数字减影血管造影；经皮肝胆道镜；肝胆管结石；经皮经肝胆道置管引流 　　[中图分类号] R657.42 [文献标识码] A [文章编号] 1673-7210（2016）05（a）-0109-05 　　[Abstract] Objective To compare two different puncture guided methods on establishing channel before treating percutaneous transhepatic cholangioscopy （PTCS） for the hepatolithiasis. Methods The clinical data of 38 patients with hepatolith in Fifth Peoples Hospital of Dongguan City from April 2014 to October 2015 were retrospectively analyzed. 20 cases using ultrasound guided percutaneous transhepatic cholangial drainage （PTCD） for establishing preoperative lithotomy channel were as group A， 18 cases using DSA guided PTCD for establishing preoperative lithotomy channel were as group B. The indexes of two groups in bile duct puncture accuracy， total puncture time， success rate of placing the biliary drainage catheter， amount of time of place the biliary drainage catheter， X-ray radiation dose， puncture path rationality， the incidence of complications， stone take net rate were compared and analyzed. Results Bile duct puncture accuracy， total puncture time， X-ray radiation dose， the incidence of complications in group A was better than those in group B， the differences were statistically significant （P 0.05）. The success rate of placing the biliary drainage catheter， the amount of time of place the biliary drainage catheter， puncture path rationality， stone take net rate in group B was better than those in group A， the differences were statistically significant （P