超声引导下经皮肝穿刺胆道引流术在治疗恶性梗阻性黄疸中的应用价值

摘要

目的 分析超声引导下经皮肝穿刺胆道引流术(uhrasound-guidedpercutaneous transhepaticcholangial drainage,US-PTCD)在治疗恶性梗阻性黄疸中的临床应用价值.方法 收集2016年1～9月我院行US-PTCD术的恶性梗阻性黄疸患者26例,计算穿刺成功率,记录并比较术前及术后丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBIL)及直接胆红素(DBIL)的变化情况.结果 26例患者中24例一次性穿刺成功,成功率约92.1％,2例患者第二次穿刺成功,整体穿刺成功率100％(26/26).其中左路穿刺21例,右路穿刺5例,术后患者均无严重并发症出现,2例患者术后2～3周内因引流管堵塞,又进行了二次置管.PTCD术后两周复查肝功能,ALT、GGT、ALP、TBIL、DBIL较术前均显著下降,患者临床症状得到显著改善,治疗前后差异统计学意义(P＜0.05).结论 US-PTCD是一种简单有效、精准、安全性高的辅助治疗恶性梗阻性黄疸的有效方法,可以明显提高长期梗阻患者肝功能,改善全身症状,提高部分早期肿瘤患者的手术成功率,降低术后死亡率;可减轻晚期肿瘤患者痛苦,提高生活质量,延长生存期,值得临床推广.%Objective To analyze the clinical application value of ultrasound-guided percutaneous transhepatic cholangial drainage (US-PICD) in the treatment of malignant obstructive jaundice.Methods We collected 26 cases with malignant obstructive jaundice undergone US-PTCD in our hospital between January 2016 and September 2016.The puncture success rate was calculated.At the same time,the changes in alanine aminotransferase (ALT),glutamyltranspeptidase (GGT),alkaline phosphatase (ALP),total bilirubin (TIBIL) and direct bilirubin (DBIL) were recorded and compared before and after operation.Results Of the 26 patients,24cases were successfully carried out by US-PTCD with one time and 2 with twice.The total success rate was 100％.Of the all patients,21 cases were carried out passing through the left lobe of liver and another 5 cases were right lobe of liver.No serious complications happened in all the patients.There were 2 cases performing a secondary puncture due to biliary sludge in the drainage tube after 2 to 3 weeks.The liver function was re-examined after two weeks of PTCD.The levels of ALT,GGT,ALP,TBIL and DBIL were decreased significantly.The clinical symptoms were improved significantly (P ＜ 0.05).Conclusion US-PTCD is an efficient treatment for malignant obstructive jaundice with advantages of convenience,accuracy and safe.It can obviously improve patients' liver function and systemic symptoms.Meanwhile,it can improve the success rate of surgery,reduce postoperative mortality,and reduce the pain of patients with advanced cancer,improve the patients' living quality,prolong the survival period.It is worthy of clinical promotion.