摘要
目的探讨经皮肝穿胆道引流术中如何获得安全穿刺道。方法将近4年108例梗阻型黄疸病例纳入研究,其中恶性梗阻患者95例,良性梗阻13例。所有患者均采用两步法诊治。第1步穿刺肝门区较粗大胆管造影,显示外周胆管较满意;第2步退出穿刺针,寻找1支较合适外围胆管作为目标胆管穿刺置管治疗。结果所有患者均造影、治疗成功,手术成功率100%;肝功能、症状及体征均有不同程度好转或消失。术后新发胆系感染6例(5.6%);胆道出血5例(4.6%);症状性胆汁漏2例(1.9%),腹腔及肝包膜下少量出血2例(1.9%),胰腺炎1例(0.9%),未出现致死病例。结论熟练的手术技巧,正确的穿刺方法所获得的安全穿刺道可以大大缩短手术时间,提高手术安全性。
Objective To investigate how the puncturing tract can be safely achieved in performing percutaneous transhepatic biliary drainage. Methods A total of 108 cases with obstructive jaundice encountered in past four years were enrolled in this study. The primary diseases included malignant lesions （n = 95） and benign lesions （n = 13）. Two-step method of diagnosis and treatment was employed in all patients. First step： puncturing of the thick biliary tract at hepatic portal area with subsequent cholangiography was carried out to obtain satisfactory images of the peripheral bile duct. Second step： the puncture needle was removed and a suitable peripheral bile duct was selected which was used as the target puncturing bile duct for catheter treatment. Results The technical success rate was 100% in angiography and drainage treatment. Different degrees of improvement in liver function and clinical symptoms were obtained in all patients. Postoperative complications included newly-developed hiliary tract infection （n = 6, 5.6%）, hemobilia （n = 5, 4.6%）, symptomatic bile leakage （n = 2, 1.9%）, mild hemoperitoneum and subcapsular hemorrhage of liver （n = 2, 1.9%）, and pancreatitis （n = 1, 0.9%）. No death occurred. Conclusion Skilled surgical manipulation and correct puncturing method can obtain a safe puncture route, by which the operation time can be greatly shortened and the surgical safety can be markedly improved. （J Intervent Radiol, 2012, 21： 860-863）
出处
《介入放射学杂志》
CSCD
北大核心
2012年第10期860-863,共4页
Journal of Interventional Radiology
