彩色多普勒超声引导下PTCD技术的选择与应用

目的探讨彩色多普勒超声在经皮经肝胆管穿刺置管引流术(PTCD)中引导穿刺技术和方法,提高PTCD的成功率。方法应用彩色多普勒超声引导对46例梗阻性黄疸患者进行54人次PTCD术,其中选择左外叶下段支胆管进针置管者34例38人次,右前叶支胆管进针置管者12例16人次,均将引流管置入患者扩张的胆管内并保留。结果46例54人次PTCD术中,1次性成功率达87%(40/46),2次性成功率达96%(44/46),3次性成功率达100%(46/46)。选择左外叶下段支胆管穿刺置管一次性成功率达91%(31/34),右前叶支胆管一次性成功率为75%(9/12)。穿刺胆管扩张范围为3~11 mm。病人临床症状均明显改善。结论彩色多普勒超声引导下的PTCD具有穿刺置管简便、实时、安全、微创、准确率高的优点,选择左外叶下段支胆管穿刺置管成功率较右叶支高。

Application of percutaneous transhepatic cholangial drainage under the guidance of color Doppler ultrasound

Objective To discuss the technique of ultrasonically guided percutaneous transhepatic cholangial drainage(PTCD) in order to improve the success rate.Methodes Fifty-four cases PTCD were performed in 46 obstructive jaundice patients under the guidance of color doppler ultrasound.Thirty-eight PTCD cases were carried out in 34 patients by pass through the inferior segmental biliary duct of the left lateral lobe.Sixteen PTCD cases performed in 12 patients through the anterior branch of the right biliary duct.Finally,tube were inserted to the target biliary duct in all cases.Results The successful rates of once centesis,twice centesis and thrice centesis were 87%,96% and 100% respectively.The successful rates of once PTCD were 91% when punctured by the inferior segmental biliary duct of the left lateral lobe.While the successful rates were only 75% when punctured by the anterior branch of the right biliary duct.The diameter of biliary duct was ranged from 3 to 11 mm.Symptoms alleviated obviously after PTCD.Conclusion Application of PTCD under the guidance of color doppler ultrasound is safely and effective.The inferior segmental biliary duct of the left lateral lobe for PTCD is more effective compared with other ways.