摘要
目的探讨联合运用超声及X线引导穿刺在恶性胆道梗阻介入治疗中的应用价值。方法 60例经病理组织学或影像学证实的恶性胆道梗阻患者采用随机数字表法均分为A、B两组,接受介入治疗,包括胆管外引流术及胆道支架置入术;A组采用传统的X线引导,B组采用超声及X线联合引导。比较两组患者术前血清总胆红素水平、穿刺次数、穿刺过程中的透视时间、对比剂用量、手术失血量、胆道出血例数、术后血清总胆红素下降情况。结果两组患者术前的血清总胆红素水平分别为(431.7±125.3)μmol/L及(427.5±128.2)μmol/L(P>0.05)。两组患者均穿刺成功并完成后续介入治疗,穿刺次数分别为(4.9±2.2)次及(1.2±0.4)次(P<0.001),穿刺过程透视时间分别为(191.0±67.2)s及(26.8±5.5)s(P<0.001),对比剂用量分别为(34.6±6.5)ml及(10.2±2.4)ml(P<0.001),手术失血量分别为(56.3±21.7)ml及(10.8±3.5)ml(P<0.001)。胆道出血例数分别为8例及0例(P<0.005),术后1周血清总胆红素分别为(79.0±20.6)μmol/L及(57.9±21.7)μmol/L(P<0.001)。结论在恶性胆道梗阻的介入治疗中联合运用超声及X线引导穿刺可以明显降低穿刺次数、透视时间、对比剂用量、手术失血量及胆道出血率,提高疗效。
Objective To investigate the application value of puncture under combined guidance of ultrasound and X-ray in interventional treatment of malignant biliary obstruction. Methods Sixty patients with malignant biliary obstruction confirmed histopathologically and imaging were randomly divided into group A and group B averagely. Then interventional treatment was performed,including external drainage and bilitary tract stent implantation. Patients in group A were treated under X-ray guidance,while in group B were treated under combined guidance of X-ray and ultrasound. The preoperative level of total bilirubin (TB) in serum,times of puncture,the fluoroscopy time and the dose of contrast medium during the puncture,as well as the intraoperative blood loss,the number of biliary hemorrhage and the descend degree of total bilirubin in serum after the operation were compared between two groups. Results The preoperative level of total bilirubin in serum in two groups was (431.7±125.3)μmol/L and (427.5±128.2)μmol/L (P0.05),respectively. Patients in each group were successful punctured and completed subsequent interventional treatment. Times of puncture were 4.9±2.2 and 1.2±0.4,respectively (P0.001). The fluoroscopy time during the puncture was (191.0±67.2)s and (26.8±5.5)s,respectively (P0.001). The dose of contrast medium during the puncture was (34.6±6.5)ml and (10.2±2.4)ml,respectively (P0.001). The intraoperative blood loss was (56.3±21.7)ml and (10.8±3.5)ml,respectively (P0.001). The number of cases of biliary hemorrhage was 8 and 0,respectively (P0.005),and the descend degree of serum total bilirubin one week after operation was (79.0±20.6)μmol/L and (57.9±21.7)μmol/L (P0.001),respectively. Conclusion Combined guidance of ultrasound and X-ray for the puncture has clinical value in interventional treatment of malignant biliary obstruction. It can not only reduce the times of puncture,the fluoroscopy time,the dose of contrast medium,th
出处
《中国医学影像技术》
CSCD
北大核心
2010年第12期2360-2363,共4页
Chinese Journal of Medical Imaging Technology
基金
江苏省卫生厅医学科技发展基金(H200937)
关键词
超声检查
阻塞性黄疸
放射学
介入性
Ultrasonography
Obstructive jaundice
Radiology
interventional