超声引导经皮肝胆道引流术治疗恶性胆道梗阻102例分析

目的 评价超声引导下经皮肝胆道引流术(PTCD)治疗恶性胆道梗阻的临床疗效。方法 对102例不能手术根治的恶性胆道梗阻患者行超声引导PTCD术。其中肝门部胆管阻塞(A组)68例，胆总管阻塞(B组)34例。内外引流57例，外引流45例。行左路术式88例，右路术式3例，左路 右路术式11例。A组中11例合并右肝管阻塞者行左路 右路术式的左右肝管双管外引流。102例中82例患者完整随访。结果 102例患者置管成功率100％，无1例出现胆漏、出血等穿刺并发症。A、B两组术后疗效优良率分别达到95．6％、100％。经十二指肠乳头的内外引流术较不经十二指肠乳头的内外引流术，术后胆道感染和胰腺炎的发生率明显增高。外引流和内外引流两种引流方式之间的疗效及生存率差异无显著性意义。PTCD换管次数与生存期呈正相关。结论 超声引导PTCD是姑息性治疗手术不能根治的恶性胆道梗阻的有效方法，超声引导左路术式的胆汁引流成功率高且安全，术后监控引流管引流通畅是提高生存期的关键。

Analysis of ultrasound-guided percutaneous transhepatic cholangiography and drainage for treating malignant biliary obstruction in 102 patients

Objective To evaluate the feasibility and safety of ultrasound-guided percutaneous transhepatic cholangiography and drainage(UGPTCD) for treating malignant biliary obstruction. Methods One hundred and two consecutive patients with malignant biliary obstruction,who could not get complete treatment by operation,underwent UGPTCD,including 68 patients with hilar bile duct obstruction(group A) and 34 patients with common bile duct obstruction(group B). External drainage was performed in 45 patients,and internal-external biliary drainage in 57 patients. Left lobe drainage mode was conducted in 88 patients,left plus right lobe drainage mode in 11 patients. Eleven cases complicated with right hepatic duct obstruction(in group A) received left and right hepatic duct drainage by the left-plus right lobe drainage mode.Complete follow-up was made on 82 cases out of 102 patients. Results Ultrasound-guided catheter placement was all successful in 102 patients,the rate being 100%,no complications such as bile leaking,bleeding occurred.The post-operative good effective rates for group A and B were 95.6 %,100%. Compared with internal-external biliary drainage not passing through duodenum nipple,those cases passing through duodenum nipple had much more incidence of post-PTCD complications such as cholangitis and pancreasis.There was no significant difference in efficiency and survival rate between the external drainage and internal-external biliary drainage. The number of changing tube of biliary drainage was positive correlated to the survival time. Conclusions UGPTCD is an efficient technique to treat patients with malignant biliary obstruction who are impossible to be cured by operation, while left-sided biliary drainage guided by ultrasound is a highly successful and safe method,monitoring the biliary drainage tube is the key to improve survival time.