超声引导下PTCD治疗梗阻性黄疸.docVIP

超声引导下PTCD治疗梗阻性黄疸 张炜炜,孔文韬,周?铁,邵宁一,徐寒子,仇毓东 【摘要】?目的?探讨超声引导下PTCD的操作技术及其临床应用价值。方法?15例梗阻性黄疸患者,14例肝门部胆管癌,1例肝癌合并胆总管癌栓,在超声引导下行PTCD术,穿刺肝左叶胆管6例,右叶胆管9例,术后常规胆道造影。结果?穿刺成功率100%,未出现出血、胆汁性腹膜炎等并发症。术后一周胆红素平均下降80.5umol??L。其中9例不能手术切除的肿瘤患者黄疸减退后带管出院,5例患者经胆道引流黄疸减退后行肿瘤根治性切除,1例肝门部胆管癌合并肝转移患者术后1月死亡。结论?超声引导下PTCD是一种治疗梗阻性黄疸的有效方法,具有安全、并发症少的优点,与X线相结合,可明显提高手术成功率。 【关键词】?超声;梗阻性黄疸;PTCD 【中图分类号】?R657.3???【文献标识码】?A??【文章编号】?100624761(2005)0220115203 OBSTRUCTIVEJAUNDICETREATEDBYULTRASOUNDGUIDEDPERCUTANEOUSTRANSHEPATICCHOLANGIO-GRAPHICDRAINAGE?(ZHANGWei2wei,KONGWen2tao,ZHOUTie,etal.DepartmentofHepato2biliarySurgery,Nan2jingDrumTowerHospital,AffiliatedtoMedicalSchool,NanjingUniversity,Nanjing,210008,China.) 【Abstract】?Objective?Tostudytheclinicalapplicationvalueofthepercutaneoustranshepaticcholangiographic drainageguidedbyultrasoundinthetherapyofobstructivejaundice.Methods?15patientswithobstructivejaundiceweretreatedbypercutaneoustranshepaticcholangiographicdrainageunderguidanceofultrasound,including14caseswithkelastincholangiocarcinomaand1casewithhepaticcarcinomaincombinationwithtumorembolisminthecommonbileduct.Leftlobedrainagewasperformedin6cases,andrightlobedrainagewasperformedin9cases .AfterPTCDcholangiographywascon2ductedineachpatient.Result?Thesuccessfulratewas100%,nocomplicationssuchasbleeding,bileperitonitisoccurred.Theaveragedeclineoftheserumtotalbilirubinwas80.5umol??L.Among15patients,9caseswhowereimpossibletobe curedbyoperation leavedhospitalafterjaundicewere regressed,5casesunderwentoperationsafterPTCDaspre2 5 11肝胆外科杂志2005年4月第14卷第2期?JournalofHepatobiliarySurgery,Vol.14,No.2,Apr.2005 n1995-2006?Tsinghua?Tongfang?Optical?Disc?Co.,?Ltd.???All?rights?reserved. operationtreatment,and1casewithkelastincholangiocarcinomaincombinationwithhepaticmetastasisdied1monthafterPTCDwasperformed.Conclusion?Percutaneoustranshepaticcholangiographicdrainageundertheguidanceofultrasoundisaneffectivetechnique,whichissafeandhaslittlecomplicationtotreatpatientswithobstructivejaundice.Thedrainageguid2edbyUScombinedwiththeX2