UG-PTCD治疗恶性梗阻性黄疸临床价值探讨
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[摘要] 目的：探讨超声引导下经皮经肝穿刺胆道引流(UG-PTCD)在操作过程中存在的利弊因素，以便切实有效地改进操作过程，以期提高UG-PTCD的成功率及时有效减少患者痛苦。方法：梗阻性黄疸疾病33例，均采用超声引导的PTCD术治疗。结果：PTCD术穿刺1次成功32例，2次成功1例，无失败，无显著并发症发生。结论：UG-PTCD术是一种比较安全、简便、经济、可靠的治疗梗阻性黄疸的姑息性方法，可以取代X线下引导的PTCD。
[关键词] 梗阻性黄疸；经皮经肝穿刺胆道引流；超声引导；临床价值
[中图分类号] R657.4 [文献标识码]A[文章编号]1674-4721(2011)07(b)-027-03
The clinical value of UG-PTCD treatment in m alignant obstructive jaundice
ZHU Guangqing1, LIU Yonggang2, ZHU Xing2
1.Department of Ultrasonography, the Fourth People's Hospital of Shenyang City, Liaoning Province, Shenyang 110031, China; 2.Department of Hepatobiliary Surgery, the Fourth People's Hospital of Shenyang City, Liaoning Province, Shenyang 110031, China
[Abstract] Objective: To ultrasound-guided percutaneous transhepatic biliary drainage (UG-PTCD) during operation of the pros and cons exist in order to effectively improve operational processes to improve the success rate of UG-PTCD timely and effective in reducing the suffering of patients. Methods: Obstructive disease, 33 cases were guided by ultrasound treatment PTCD. Results: PTCD puncture a successful surgery in 32 cases, 2 were successful in 1 case, no failure, no significant complications. Conclusion: UG-PTCD surgery is a relatively safe, simple, economical and reliable palliative treatment of obstructive jaundice approach, it can replace the X-line guidance PTCD.
[Key words] Obstructive jaundice; UG-PTCD; Ultrasound-guided; Clinical value
恶性梗阻性黄疸(m alignant obstructive jaundice，MOJ)是肿瘤晚期的临床表现之一，既往多采用外科手术治疗，但重度黄疸手术死亡率高达20%，经皮肝穿刺胆道引流(PTCD)作为一种微创的诊疗方法，近年来在肝胆胰疾病的治疗中日益推广。本科采用超声引导下(UG-PTCD)治疗梗阻性黄疸33例，总结对UG-PTCD的可行性和成功率进行分析探讨，以利提高UG-PTCD术在临床的应用价值。现报道如下：
1 资料与方法
1.1 一般资料
本院2004年1月～2009年12月住院患者33例，其中，男24例，女9例，年龄53～81岁，平均77岁。33例患者均系梗阻性黄疸患者，经手术、CT、ERCP等证实，高位胆管癌15例，胰头癌9例，壶腹癌3例，结肠癌和胃癌术后肝门淋巴结转移致梗阻性黄疸2例，ERCP术后梗阻性黄疸4例。
1.2 治疗方法
采用ALOKA-5500型彩色超声诊断仪，频率3.5 MHz，穿刺导向装置，日本八德18G-PTC穿刺针， COOK公司生产 8.5F猪尾巴外引流管，特细导丝，另自备麻药(2%利多卡因)，专用PTCD无菌手术包等。术前常规检查肝功、血小板计数、凝血酶原时间等实验室检查。患者取仰卧位或左侧卧位，先用超声探测确定肝内扩张胆管的属支情况，扩张胆管的直径及穿刺方向进针距离，取一个较满意的穿刺目标胆管，估计引导丝行进路线，总结路径见表1。
选准穿刺点后做标记，以此处为中心用碘伏进行半径约20 cm的皮肤消毒，铺巾，探头罩上无菌套安装穿刺设备，在定位点上用2%利多卡因进局麻直至肝被膜，然后用手术刀切一约5 mm小口，深度贯穿皮肤全层至皮下脂肪层 ......
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