摘要
目的观察探讨彩超介导经肝胆管穿刺并置流对梗阻性黄疸患者的临床价值。方法选取我院2013年2月至2015年2月收纳的26例梗阻性黄疸患者,对于胆管梗阻部位进行彩超下经皮肝胆管穿刺置流术,将引流管置入患者胆管内并保留。回顾性分析26例梗阻性黄疸患者穿刺置管次数及成功率。结果 26例梗阻性黄疸患者中在彩超介导下进行经皮肝胆管穿刺置流的成功率100%,一次经皮肝胆管穿刺置流成功22例,成功率84.61%,二次经皮肝胆管穿刺置流成功3例,成功率11.53%,3次经皮肝胆管穿刺置流成功1例,成功率3.85%。本组26例中15例梗阻性黄疸患者采取左外叶下段支胆管进针,9例梗阻性黄疸选择右前叶支胆管进针。左外叶下段进针一次性成功率为93.33%(14/15),右前叶支进针一次性成功率为66.67%(6/9)。穿刺置管引流后患者均在2周后好转,临床皮肤巩膜黄染,腹痛,皮肤瘙痒症状显著缓解。总胆红素从388μmol/L下降到31μmol/L,直接胆红素从76μmol/L下降到17μmol/L。仅一例患者发生胆漏,无严重并发症发生。结论彩色多普勒介导经肝胆管穿刺并置流对梗阻性黄疸患者有重要意义,提高了穿刺置管的安全性,具有安全简便,微创,准确率高等特点,从左外叶下段通过彩色多普勒超声经皮肝胆管穿刺成功率较高,具有临床推广价值。
Objective To observe the clinical value of ultrasound mediated bile duct puncture and drainage in the treatment of patients with obstructive jaundice. Methods 26 cases of patients with obstructive jaundice in our hospital from February 2013 to February 2015 were selected,and the bile duct puncture at obstruction position was performed by color Doppler ultrasound,the drainage tube was inserted into the bile duct and retained. The number and success rate of puncture in 26 patients with obstructive jaundice were analyzed retrospectively. Results The successful rate of percutaneous biliary puncture under color Doppler ultrasound of 26 cases of patients with obstructive jaundice was 100%. 22 cases of percutaneous biliary puncture got success in one time and success rate was 84.61%,3 cases achieved success in percutaneous transhepatic puncture in 2 times and the success rate was 11.53%,only 1 case obtained success in 3 times and the success rate was 3.85%. In the group of 26 patients,15 cases of puncture through the left lateral lobe inferior segmental bile duct,9 cases of puncture through right front lobus. One time successful rate of puncture through inferior segment of left lateral was93.33（ 14 / 15）,it was 66. 67%（ 6 / 9） through right anterior lobe. The patients got clinical improvement after percutaneous catheter drainage for 2 weeks. Symptoms,including jaundice,abdominal pain and skin itching were improved. Total bilirubin decreased from388 mmol / L to 31 mmol / L,direct bilirubin decreased from 76 mmol / L to 17 mmol / L. Only one case of patients with bile leakage,no serious complications occurred. Conclusions Color Doppler mediated bile duct puncture and drainage plays an important role in the patients with obstructive jaundice,it improves the puncture safety. Has the advantages of safe,simple,minimally invasive and higher accurate rate. It will got high success rate when puncture from the left lobe segment,it is worthy of clinical promotion.
出处
《齐齐哈尔医学院学报》
2016年第21期2631-2633,共3页
Journal of Qiqihar Medical University
关键词
彩超
肝胆管穿刺
置流
梗阻性黄疸
Ultrasonography
Biliary obstructive jaundice
Drainage
Obstructive jaundice
