摘要
目的精确测定肝内扩张胆管位置,设计穿刺途径,提高经皮肝穿胆道造影术(PTC)成功率。方法对73例恶性阻塞性黄疸患者进行PTC,其中30例采用经皮肝穿靶胆管定位方法穿刺为实验组,43例采用传统法为对照组。实验组:在CT或MRI片上,取肝内胆管扩张最明显的层面,选择外周直径合适,与预计针道走行方向呈锐角的肝内胆管分支为靶胆管,靶胆管中点作为穿刺进入点,测量穿刺进入点至背部体表的距离为h值,h值为确定穿刺层面的参考值;分别测量靶胆管两端至腹部(矢状面)正中线距离为a值和b值,(a-b)值为靶胆管体表投影区的参考值;穿刺点定在h值层面与右侧肋膈角下2个肋间隙肋骨上缘相交点,针尖对准靶胆管体表投影区进行水平穿刺。对照组:取右侧腋中线肋膈角下2个肋间隙(常为第8～10肋间隙肝脏中部)肋骨上缘为穿刺点,针尖指向胸10～胸12椎体之间进行水平穿刺,至接近椎体右缘2～6cm处。结果实验组穿刺次数为1～4次,共62次,每例平均2.07次,成功率为48.4%;对照组穿刺次数为1～9次,共186次,每例平均4.33次,成功率为23.1%;两组比较具有显著性差异(χ2=14.294,P﹤0.01)。结论经皮肝穿胆道造影术靶胆管定位穿刺准确测定可提高穿刺成功率,减少肝脏损伤等并发症,对PTC是一种有效方法。
Objective To precisely localize the dilated intrahepatic bile duct, design correct puncture route and enhance the success rate in percutaneous transhepatic cbolangiography （PTC）. Methods Seventy-three patients with malignant obstructive jaundice underwent percutaneous transhepatic cholangiography, of which 30 cases were assigned in the experimental group with percutaneous transhepatic biliary target positioning puncture method, and the other 43 cases were of the traditional method as the control group. Experimental group： The targeted biliary duct was selected on the CT or MRI image as the most obvious intrahepatie dilated biliary duct level; with appropriated external diameter and acute angulation to the puncture needle route. The puncture site was at the middle of the targeted duct and then followed by measuring the distance between the puncture point to the dorsal surface as value h. designated for the reference of puncture level. Separately measuring the distances （on the saggital image） from the two terminals of the targeted duct to the abdominal median line as values a and b. （a-b） for the reference value of the targeted duct surface projection area. The puncture point was selected at the intersection of value h level and the upper rib border of the 2nd intercostal space below sight costophrenic angle and then the puncture needle was puched into the targeted duct surface projection area horizontally. Control group： The puncture point was selected at the upper border of rib located approximately two intercostals spaces below the right median axillary line of costophrenic angle （commonly at the middle part of liver within 8th - 10th intercostals space）. The direction of puncture needle was passed through horizontally between T10 and T12 into the tissue 2 - 6 cm, adjacent to the sight vertebral body. Results The number of puncture was 1 - 4 （average 2.07） for each individual with totally 62 times and successful rate 48.4% for experimental group and those for the control group were 1 - 9
出处
《介入放射学杂志》
CSCD
2008年第11期793-795,共3页
Journal of Interventional Radiology
关键词
经皮肝穿胆道造影术
靶胆管
定位
穿刺
放射学
Percutaneous transhepatic cholangiography, prFC
Targeted duet
Positioning
Puncture
Radiology
