经皮肝穿刺胆道造影和引流的临床应用.docVIP

经皮肝穿刺胆道造影和引流的临床应用 【摘要】 目的 加强对经皮肝穿刺胆道造影（ PTC）和引流（PTCD）操作过程中要点和术后并发症的认识。 方法 15例不明原因的胆道梗阻患者，经B超和X线透视下定位后，采用Chila针经皮肝穿刺胆道造影，确定了梗阻的部位、性质后，其中8例患者放置了内外引流管或外引流管。 结果 15例行经皮肝穿刺胆道造影患者,经手术探查和病理证实13例,另2例因一般情况差,无法手术,诊断正确率达87%; 8例行引流术患者,均取得了引流成功,明显缓解了症状,其中6例胆道梗阻严重者,经引流2周后实施手术探查。无1例发生严重并发症。 结论 通过对15例梗阻性黄疸的造影诊断和引流的操作要点和并发症的论述，有助于该项技术在临床中更好地应用和推广。 【关键词】 外科学；穿刺；胆道；造影；引流 【Abstract】 Objective To get a better understanding of the operating process of PTC and PTCD and potential accompanied diseases after operation. Methods Chila needles were used on 15 patients with bile-duct obstruction for unknown causes after B- ultrasound scan and X- ray perspective. After the obstruction spot and its nature were confirmed, 8 of them were laid aside inside and outside PTCD catheters or only outside ones. Results After PTC exploration and pathological analysis, 13 patients were authenticated while two of them were unable to be operated on for bad conditions, and the diagnosis accuracy was up to 87%; PTCD were successfully conducted on 8 patients and the symptoms were obviously alleviated, without serious diseases accompanied. Conclusion Through the 15 examples of PTC diagnoses of obstructive jaundice and main points of PTCD and accompanied diseases, this technology should be better applied and further promoted. 【Key words】 surgery; puncture; biliary passage; percutanevus transhepatic cholangiography(PTC); PTCD 经皮肝穿刺胆道造影（ PTC）和引流（PTCD）在临床上已广泛应用于梗阻性黄疸的诊断和治疗［1］。我院自1997年开展此项技术，15例胆道梗阻的患者经PTC术后，均明确了梗阻部位及原因，其中8例患者行PTCD术。本文结合手术所见、病理结果，浅谈应用体会及注意事项。 1 资料与方法 1.1 临床资料 15例胆道梗阻病例，其中男10例，女5例；年龄45～76岁，平均62岁。主要临床表现为皮肤瘙痒不适、全身皮肤及巩膜明显黄染，经B超及CT检查诊断为胆道系统扩张。 1.2 术前准备 1.2.1 患者准备 (1) 黄疸患者应做生化检查,以鉴别肝细胞性黄疸还是梗阻性黄疸；（2）术前进行B超检查，并做好穿刺点的体表定位，以提高穿刺成功率；（3）术前3天测定出凝血时间和凝血酶原时间，如果时间延长75%，需给予纠正；（4）术前2天给予预防性抗生素治疗，术前1天做好普鲁卡因和碘过敏试验；（5）术前30min给予镇定药和镇痛药，并向患者说明操作过程，以取得患者理解和配合。 1.2.2 器械准备 (1) 千叶针(Chiba针): 内径0.4mm， 外径0.7mm；（2）带聚乙烯套管的穿刺针：长20cm，内径1cm，外径1.6cm；（3）扭控导引钢丝和交换导引钢丝各1根