| 武中林,李顺宗,杨光,谷铁树,吴勇超,荣小翠,李智岗.超声引导肝内胆管穿刺在老年高位恶性胆道梗阻中的应用[J].中国介入影像与治疗学,2017,14(6):365-369 |
| 超声引导肝内胆管穿刺在老年高位恶性胆道梗阻中的应用 |
| Application of ultrasound-guided intrahepatic biliary puncture in elderly patients with malignant hilar biliary obstruction |
| 投稿时间：2016-11-06 修订日期：2017-04-20 |
| DOI：10.13929/j.1672-8475.201611007 |
| 中文关键词: 恶性胆道梗阻 超声检查 血管造影术,数字减影 |
| 英文关键词:Malignant biliary obstruction Ultrasonography Angiography, digital subtraction |
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| 中文摘要: |
| 目的 探讨超声引导下肝内胆管穿刺联合DSA胆道双支架植入内引流治疗老年高位恶性胆道梗阻（MHBO）的临床应用价值。方法 收集老年MHBO患者108例，超声组54例在超声引导下行肝内胆管穿刺，DSA组54例在DSA下行肝内胆管盲穿；2组患者穿刺成功后，于DSA下视情况行胆道双支架植入内引流、胆道单支架植入并对侧外引流、胆道完全外引流及优势侧胆道外引流；分析2组患者肝内胆管穿刺、近期并发症及4种胆道引流方式的疗效。结果 超声组患者胆管穿刺次数、穿刺对比剂用量、胆道出血及穿刺点疼痛发生率明显小于DSA组（P均<0.05），1次穿刺成功率明显高于DSA组（P<0.05）。4种胆道引流方式术后第14天肝功能指标及术后第21天总胆红素（TBIL）值组间两两比较差异均有统计学意义（P均<0.05）。结论 超声引导穿刺技术联合DSA胆道双支架植入内引流治疗老年MHBO有明显的临床实用价值。 |
| 英文摘要: |
| Objective To explore the clinical application value of ultrasound-guided intrahepatic biliary puncture combined with internal double biliary stenting under DSA in elderly patients with malignant hilar biliary obstruction (MHBO). Methods Totally 108 elderly MHBO patients received interventional treatment were analyzed retrospectively. Half of patients were treated with ultrasound-guided intrahepatic biliary puncture (ultrasound group), and another 54 patients were treated with DSA intrahepatic biliary puncture (DSA group). After successful puncture, the patients received percutaneous transhepatic cholangial drainage (PTCD) with 4 methods under DSA guidance, namely internal double biliary stenting, contralateral external PTCD with single biliary stenting, complete external PTCD and external PTCD on the dominant side. The recent complications of intrahepatic biliary puncture at two groups and the curative effect with four methods were observed. Results The frequency of intrahepatic biliary puncture, the dosage of contrast agent, the incidence of pain at the puncture point and hemobilia in ultrasound group were all lower than those in DSA group (all P<0.05), the successful rate of intrahepatic biliary puncture in first time was significantly higher compared with DSA group (P<0.05). The liver function indicators at 14 days postoperation and total bilirubin at 21 days postoperation had statistical differences between any two biliary drainage methods (all P<0.05). Conclusion Ultrasound-guide intrahepatic biliary puncture combined with internal double biliary stenting under DSA can significantly benefit elderly patients with MHBO. |
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