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目的探讨超声引导下经皮肝穿胆道引流术(PTCD)治疗梗阻性黄疽的临床疗效。方法 16例梗阻性黄疸患者行超声引导下PTCD,术后观察患者临床症状的变化,记录每日胆汁引流量,复查肝功能指标。结果 16例患者均穿刺成功,术后3~6d患者症状均有明显好转,黄疸减轻,皮肤瘙痒缓解,腹胀痛、纳差及乏力也得到明显改善,食欲增加,血清总胆红素水平下降。1例临床症状缓解后行胰十二指肠切除术,成功切除肿瘤。除1例置管脱落,1例合并胆道出血,其余均无明显并发症,患者生活质量得到明显的改善。结论超声引导下PTCD治疗梗阻性黄疸疗效显著,减轻患者黄疸症状,改善肝功能,延长肿瘤患者的生存时间,并且通过技术改良提高重症患者的穿刺成功率和安全性,为部分患者的进一步外科手术治疗提供可能性。
Objective To investigate the clinical efficacy of ultrasound-guided percutaneous transhepatic biliary drainage (PTCD) in the treatment of obstructive jaundice. Methods Sixteen patients with obstructive jaundice underwent ultrasound guided PTCD. The clinical symptoms were observed after operation. The daily bile drainage was recorded and the liver function indexes were reviewed. Results All the 16 patients were successfully punctured. The symptoms of patients were obviously improved after 3 ~ 6 days. The jaundice was relieved, the pruritus of the skin was relieved, abdominal pain, anorexia and fatigue were also significantly improved, the appetite increased and the level of serum total bilirubin decreased. One patient underwent pancreatoduodenectomy after the clinical symptoms were relieved, and the tumor was successfully resected. In addition to a case of catheter shedding, biliary bleeding in 1 case, the remaining no significant complications, patients with significant improvement in quality of life. Conclusions Ultrasound-guided treatment of obstructive jaundice by PTCD has significant curative effect, relieves jaundice symptoms, improves liver function and prolongs the survival time of patients with cancer, and improves the puncture success rate and safety of critically ill patients through technical improvement. Treatment offers the possibility.