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1、三维超声引导下PTCD治疗恶性阻塞性黄疸的临床价值探讨作者：彭莉晴，李明星,邹庆伟单位：四川，泸州医学院附属医院超声诊断科【摘要】目的探讨在三维超声引导下经皮肝胆管穿刺置管引流术对治疗恶性阻塞性黄疸的临床价值。方法冋顾性分析35例恶性梗阻性黄疸病人在三维超声引导下行PTCD术的临床资料，对首次穿刺成功率，置管成功率，以及术前、术后两周的肝生化指标进行分析。结果35例患者共行36次PTCD,其中1例首次穿刺失败,首次穿刺成功率97.22%(35/36)；置管成功率100%；术后2周患者症状、体征均明显改善，表现为黄疸减轻，皮肤瘙
2、痒缓解，情绪好转，食欲增加,血清总胆红素由术前的103.4-621.7μmol/L降至术后两周的22.6〜201.2μmol/L,无严重并发症发生。结论三维超声下导向穿刺首次穿刺成功率和置管成功率高，术后并发症发生率低：对不宜手术的恶性阻塞性黄疸病人是较好的选择，值得临床推广应用。【关键词】三维超声；恶性梗阻性黄疸；经皮肝胆管穿刺置管引流TheClinicalValueof3-DUltrasound-guidedPTCDforMalignantObstructiveJaundicePengLiqingl,LiMin
3、gxingLZouQingwei1.UltrasonographyDepartment,AffiliatedHospital,LuzhouMedicalCollege,Luzhou,SichuanProvince6460CX),P.R.China;2.DepartmentofHepatobiliarySugery,AffiliatedHospitaLLuzhouMedicalCollege,Luzhou,SichuanProvince646000,P.R.ChinaAbstractObjectiveToprobeintothe
4、clinicalvalueof3-Dultrasound-guidedPTCDformalignantobstructivejaundice.MethodsTheclinicaldataof35casesofmalignantobstructivejaundicetreatedby3-Dultrasound-guidedPTCDwereretrospectivelyanalyized.Thefirstpuncturesuccessrateandintubationsuccessrateaswellashepaticbioche
5、micalcriterionpreoperativelyand2weekspostoperativelywereanalyzed.ResultsPTCDwasperformed36timesin35cases.Ofthese,thefirstpuncturefailedin1.Thefirstpuncturesuccessratewas97.22%(35/36)ancltheintubationsuccessrate100%.Thesymptomsandsignsofthepatientsamelioratedsignific
6、antly2weekspostoperatively.presentingwithareductioninjaundice,remissionofcutaneouspruritus,emotionalimprovement,anincreaseinanappetite,adereaseinserumtotalbilirubinfrom103.4-621.7μmol/Lpreoperativelyto22.6〜201・2μmol/L2weekspostoperativelyandnoseverecomplicatio
7、ns.ConclusionsThree-dimensionalultrasound-guidedPTCDhashighpunctureandintubationsuccessratesandalowincidencerateofpostoperativecomplications.ltisabetterchoiceforpatientswithmalignantobstructivejaunceunsuitableforoperationandworthapplicationanddissemination.KEYWORDSt
8、hree-dimensionalultrasoundmalignantobstructivejaundicePTCD临床部分晚期恶性肿瘤所致的阻塞性黄疸患者L2无手术指征，如果不能将胆汁引流，患者将会因肝功能衰竭或其他并发症而危及生命。现采用在三维超声引导下经皮经肝胆管穿刺置
