【摘要】 目的 探讨超声实时定位引导肝内胆管穿刺后DSA下行PTCD或胆道内支架置入术治疗恶性梗阻性黄疸的临床应用价值。方法 回顾分析98例恶性梗阻性黄疸行PTCD或胆道内支架置入术的临床资料。高位胆道梗阻65例,低位胆道梗阻35例。采用超声定位引导肝内胆管穿刺后DSA下介入治疗。结果 98例中23例行左右两侧胆管分别穿刺双侧介入治疗,47例行右侧穿刺治疗,28例行左侧穿刺治疗。39例行胆道支架置入,59例行PTCD。穿刺成功率100%,一针穿刺成功率90.91%。术后2周血清总胆红素明显下降,平均下降121.55μmol/L。无严重出血、胆汁性腹膜炎等并发症。结论 超声结合X线引导介入治疗梗阻性黄疸技术成功率高,安全、有效。减少了患者的痛苦,降低了手术风险。更多还原

【Abstract】 Objective To explore the clinical value for treatment of malignant obstructive jaundice by percutaneous transhepatic cholongial drainage(PTCD) and biliary tract stent implantation under the guidance of DSA after real-time ultrasound guided intrahepatic bile duct puncture.Methods 98 cases of malignant obstructive jaundice received PTCD or biliary tract stent implantation were retrospective analyzed,including 63 cases of the high bile duct obstruction and 35 cases of the low bile duct obstruction.We had interventional treatments under the guidance of DSA after the ultrasound guided intrahepatic bile duct puncture.Results In 98 cases,23 cases were performed interventional treatments by receiving the right and left bile duct puncture respectively,47 cases only received the right side puncture and 28 patients the left side puncture.In 98 cases,39 patients underwent biliary stent implantation,and 59 patients underwent PTCD.All cases had 100 % success rate of bile duct puncture,and 90.91% success rate of only one needle puncture.tow weeks after the interventional treatments,the serum levels of total bilirubin were decreased significantly,with the average declines of 121.55 μmol/L.No complications of severe bleeding,biliary peritonitis occurred.Conclusion Interventional treatment of malignant obstructive jaundice under the guidance of ultrasound and X-ray is of highly successful,safe and effective.It reduces the suffering of patient and the treatment risk.更多还原