摘要
目的 探讨超声引导下经皮肝穿刺胆管引流(PTCD)与内镜逆行胰胆管造影(ERCP)会师术的临床应用价值。方法 选取我院常规行ERCP治疗困难或失败患者17例,应用超声引导下PTCD与ERCP会师术完成诊断及治疗,比较术前及术后2 d临床症状及实验室指标的差异,观察并发症发生情况。结果 17例患者均成功完成PTCD与ERCP会师术治疗,其中采取右侧肝内胆管穿刺16例,左侧肝内胆管穿刺1例;对胆总管结石患者行内镜下取石和鼻胆管放置,对胆管梗阻或狭窄患者行胆管扩张及支架置入术。会师术前与术后2 d血白细胞计数、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶及血清淀粉酶水平比较,差异均无统计学意义;总胆红素、直接胆红素水平比较,差异均有统计学意义(均P<0.01)。术后患者胆管梗阻症状完全解除,均无严重并发症发生。结论 超声引导下PTCD与ERCP会师术成功率高、安全性好,具有较好的临床价值。
Objective To explore the clinical application value of ultrasound guided percutaneous transhepatic cholangiography drainage(PTCD)combined with endoscopic retrograde cholangiopancreatography(ERCP).Methods Totally 17 patients with difficulty or failure in ERCP treatment were selected from our hospital.Ultrasound guided PTCD combined with ERCP was used to complete diagnosis and treatment.The differences in clinical symptoms and laboratory indexes were compared before and 2 d after surgery,and the occurrence of complications were observed.Results All 17 patients successfully completed PTCD-ERCP consultation,including 16 patients with right intrahepatic bile duct puncture and 1 patient with left intrahepatic bile duct puncture.Patients with common bile duct stones underwent endoscopic stone removal and nasobiliary drainage,while those with biliary obstruction or stenosis underwent biliary dilation and stent placement.There were no significant differences in the levels of leukocytes,alanine aminotransferase,aspartate aminotransferase and amylase before and 2 d after surgery.The levels of total bilirubin and direct bilirubin were significantly different(both P<0.01).Biliary obstruction was completely relieved and no serious complications occurred after surgery.Conclusion Ultrasound guided PTCD combined with ERCP has high success rate and safety,which has good clinical value.
作者
易惠明
唐大川
王兵
张剑
张伟
YI Huiming;TANG Dachuan;WANG Bing;ZHANG Jian;ZHANG Wei(Department of Medical Ultrasound,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《临床超声医学杂志》
CSCD
2024年第1期33-36,共4页
Journal of Clinical Ultrasound in Medicine
基金
湖北省自然科学基金一般面上项目(2022CFB225)。
关键词
超声引导
经皮肝穿刺胆管引流
内镜逆行胰胆管造影
Ultrasound guided
Percutaneous transhepatic cholangiography drainage
Endoscopic retrograde cholangiopancreatography
