摘要
目的对比IQQA-Guide智能穿刺导航系统辅助下的经皮肝穿刺胆管引流术(PTBD)与同期的传统PTBD在治疗梗阻性黄疸方面的优劣,为进一步拓展电磁导航辅助PTBD的临床研究及运用提供依据。方法回顾性分析2022年3月至2023年1月56例因恶性梗阻性黄疸于东部战区总医院介入治疗科行PTBD治疗的患者临床资料。按术中穿刺胆管引导方式的不同分为电磁导航组(n=20)、传统透视组(n=36)。分析比较两组患者术前规划穿刺胆管分级及直径、术中穿刺胆管次数、术中透视时间、术中辐射剂量、术后并发症、术后血常规、肝功能等指标改变。结果电磁导航组穿刺的胆管直径小于透视组(P<0.01)。术中电磁导航组在穿刺胆管针数、透视时间、辐射剂量明显优于透视组(P<0.01)。电磁导航组及透视组PTBD的术后TBIL、ALP较术前显著下降(P<0.01)。电磁导航组HB术后变化值较透视组小(P<0.01)。电磁导航组术后3天的CRP、CRP术后变化值低于透视组(P<0.05)。透视组术后HB较术前降低,术后3天CRP较术前升高(P<0.01)。电磁导航组总体并发症发生率明显低于透视组(P<0.05)。结论经电磁导航辅助PTBD术操作简单,安全可行,能有效提高胆管穿刺成功率,减少透视时间及术中辐射,减少患者术后并发症,值得在临床中进一步推广。
Objective To compare the advantages and disadvantages of percutaneous transhepatic biliary drainage(PTBD)assisted by the IQQA-Guide intelligent puncture navigation system and traditional PTBD at the same time in the treatment of obstructive jaundice,to provide a basis for further expanding the clinical research and application of electromagnetic navigation-assisted PTBD.Methods A retrospective analysis was conducted on 56 patients who underwent PTBD treatment for malignant obstructive jaundice in the Interventional Therapy Department of the General Hospital of the Eastern Theater Command of the Chinese People's Liberation Army from March 2022 to January 2023.They were divided into electromagnetic navigation group(n=20)and fluoroscopy group(n=36)according to the different guidance methods for intraoperative biliary puncture.The preoperative classification and diameter of planned bile ductpuncture,the number of intraoperative bile ductpuncture,intraoperative fluoroscopy time,intraoperative radiation dose,postoperative complications,postoperative blood routine,liver function and other indexes were analyzed and compared between the two groups.Results The punctured bile duct diameter in the electromagnetic navigation group was smaller than that in the fluoroscopy group(P<0.01).The electromagnetic navigation group was superior to the fluoroscopy group in the number of bile duct punctures,fluoroscopy time,radiation dose(P<0.01).The postoperative TBIL and ALP of PTBD in the electromagnetic navigation group and fluoroscopy group were significantly lower than those before surgery(P<0.01).The postoperative value of HB in the electromagnetic navigation group was smaller than that in the fluoroscopy group(P<0.01).The CRP and CRP postoperative values in the electromagnetic navigation group 3 days after operation were lower than those in the fluoroscopy group(P<0.05).In the fluoroscopy group,HB was lower after surgery than before surgery,and CRP was higher 3 days after surgery than it was before surgery(P<0.01).The overall complication rate in the electromagnetic navigation group was significantly lower than that in the fluoroscopy group(P<0.05).Conclusion PTBD assisted by electromagnetic navigation is simple to operate,safe and feasible.It can effectively improve the success rate of biliary puncture,reduce fluoroscopy time and intraoperative radiation,and reduce postoperative complications for patients.It is worthy of further promotion in clinical practice.
作者
杨涛
高大志
许潭潭
史东宏
刘丽
陈佳海
许健
YANG Tao;GAO Dazhi;XU Tantan;SHI Donghong;LIU Li;CHEN Jiahai;XU Jian(Medcial Imaging College,Xuzhou Medical University,Xuzhou 221004,Jiangsu,China;Department of Interventional Therapy,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of oncology,The 910 Hospital of Joint Logistic Support Force,Quanzhou 362000,Fujian,China)
出处
《医学研究与战创伤救治》
CAS
北大核心
2023年第5期503-508,共6页
Journal of Medical Research & Combat Trauma Care
关键词
恶性梗阻性黄疸
经皮肝穿刺胆管引流术
电磁导航
影像融合技术
malignant obstructive jaundice
percutaneous hepatocentesis biliary drainage
electromagnetic navigation
image fusion technology
