【摘要】 目的 探讨超声实时引导结合X线透视下,经皮肝胆管穿刺置管引流术(PTBD)治疗肝内胆管微扩张型梗阻性黄疸的操作技术及其临床应用价值。方法 回顾性分析9例肝内胆管微扩张型梗阻性黄疸患者的临床资料,6例行右肝胆管PTBD,3例行左肝胆管PTBD。结果 胆管穿刺置管成功率100%,术后短暂性发热1例、一过性血性胆汁1例,未出现腹腔出血及胆汁性腹膜炎等严重并发症,术后一周胆红素平均下降(75.4±29.6)μmol/L。引流时间10 d~5个月。结论 超声引导结合X线透视下PTBD治疗肝内胆管微扩张型梗阻性黄疸是安全可行的。

    【关键词】

    超声;X线透视;梗阻性黄疸;经皮肝胆管穿刺置管引流术(PTBD)

    The use of PTBD in patients with obstructive jaundice with nondilated intrahepatic bile ducts

    ZHAO Zhiming,YU Dejiang,JI Wenbin,et al.Department of Hepatobiliary Surgery,Chinese PLA Jeneral Hospital,Beijing 100853,China

    【Abstract】 Objective To investigate the technical and clinical value of PTBD in patients with obstructive jaundice with nondilated intrahepatic bile ducts by the guiding of ultrasound combined with Xray scan.Methods PTBD was performed in 9 patients with with nondilated intrahepatic bile ducts,guided by combining ultrasound and Xray scan.6 patients were punctured to right bile ducts and 3 were left bile ducts.Results Technical success was obtained in all patients.There were only two minor complications:transient hemobilia(n=1)and fever(n=1).No hemorrhage and biliary peritonitis were found after procedures.The bilirubin was reduced by75.4±29.6ummol/L one week later.Conclusion Ultrasoundandfluoroscopy guided PTBD in patients with nondilated bile ducts is a safe,feasible,and efficient procedure for the palliation of biliary obstruction. ......