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目的对应用不同穿刺方法经皮肝穿刺胆道引流术(PTCD)治疗恶性梗阻性黄疸(MBOJ)的技术性、安全性及可行性进行对比。方法回顾分析2006年3月至2010年12月治疗的72例MBOJ患者的临床资料,将37例超声引导PTCD设为A组,35例DSA联合超声PTCD设为B组。结果 2组穿刺方法并发症、疗效、半年生存率及1年生存率对比显示,其疗效及术后并发症、生存率等方面无统计学差异(P>0.05),但B组内外引流率及单根管双侧引流率明显较高(P<0.01),胆道内引流管位置明显优于A组。结论经皮肝穿刺是不能根治的MBOJ较为有效的姑息性治疗方法,DSA联合超声PTCD手术成功率高,引流效果好,在实时、安全方便、操作医师接受射线剂量少方面有明显优势。
Objective To compare the technical, safety and feasibility of using percutaneous transhepatic biliary drainage (PTCD) in the treatment of malignant obstructive jaundice (MBOJ) with different puncture methods. Methods The clinical data of 72 patients with MBOJ treated from March 2006 to December 2010 were retrospectively analyzed. Thirty-seven cases of ultrasound guided PTCD were classified as group A and 35 cases of DSA combined with ultrasound PTCD as group B. Results Comparisons of the complications, curative effect, half-year survival rate and 1-year survival rate of the two groups showed no significant difference in curative effect, postoperative complications and survival rate (P> 0.05). However, Single-tube bilateral drainage rate was significantly higher (P <0.01), biliary drainage tube position was significantly better than the A group. Conclusions Percutaneous transhepatic puncture is an ineffective palliative treatment for MBOJ. The success rate of DSA combined with ultrasound PTCD is high, and the drainage effect is good. In real time, it is safe and convenient, and there are obvious advantages for operators to receive less radiation dose.