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目的评价超声引导经皮经肝胆管置管引流术在无手术适应证胆道梗阻疾病中的应用价值及疗效判断。方法本组39例,男22例,女17例。平均年龄51.2岁。使用自制穿刺辅助装置,日本八光S型引流套管(8F)。选择内径≥10 mm、走行较平坦、无扭曲的胆管为穿刺点,胆管周围加以彩色血流成像并注意避开血管。成功置管的38例中33例行左胆管置管,5例右胆管置管。结果39例除1例因术中出血未成功外,38例均成功置管,随访未发现胆漏、出血、感染等并发症。引流胆汁后患者症状明显改善,血清胆红素逐渐下降,其中6例降至正常。本组胆汁日引流量380~1400 ml。38例中术后生存2~5个月8例、>6个月15例、>9个月11例、>1年4例,最长生存期17个月。结论超声引导肝胆管置管引流,操作简便、痛苦小、成功率高,使患者得到了持续性胆汁引流的机会,对改善梗阻导致的黄疸,减轻由其产生的损害和症状,延长患者生存期及提高晚期生存质量将起到重要的积极作用。
Objective To evaluate the value of ultrasound-guided percutaneous transhepatic bile duct drainage in the treatment of biliary obstruction without surgical indications and its therapeutic effect. Methods The group of 39 patients, 22 males and 17 females. The average age is 51.2 years old. Using homemade puncture aids, Japan eight light S-type drainage tube (8F). Select the diameter ≥ 10 mm, walking more flat, no distortion of the bile duct puncture point, to be colored blood flow around the bile duct imaging and avoid the blood vessels. Of the 38 cases successfully managed, 33 received left cholangiography and 5 received right cholangiography. Results All the 39 patients except one were unsuccessfully bleeding due to intraoperative bleeding. All 38 patients were successfully catheterized. No complications such as biliary leakage, hemorrhage and infection were found. Drainage after biliary symptoms improved significantly, serum bilirubin gradually decreased, of which 6 cases dropped to normal. The group of bile daily drainage 380 ~ 1400 ml. Among the 38 cases, 8 cases survived 2 to 5 months, 15 cases> 6 months, 11 cases> 9 months and 4 cases> 1 year, the longest survival period was 17 months. Conclusion Ultrasound-guided cholangiopancreatography is simple and easy to operate with little pain and high success rate, which gives the patient the chance of sustained bile drainage, improves the jaundice caused by obstruction, reduces the damage and symptoms caused by the obstruction, prolongs the patient’s life span And improve late life quality will play an important and positive role.