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目的总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎(SAC)提供参考。方法回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果156例行PTCD均获成功,1次穿刺成功140例,其成功率达89.7%(140/156);16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解,黄疸减退,肝功能改善。结论PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者,其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。
Objective To summarize the advantages and disadvantages of percutaneous transhepatic biliary drainage (PTCD) guided by ultrasound and to provide a reference for clinical treatment of severe acute cholangitis (SAC). Methods A retrospective analysis of our hospital from August 1994 to July 2008 for 156 elderly patients with SAC under the guidance of ultrasound-guided PTCD treatment of clinical data. Results All of the 156 cases were successful in PTCD. 140 cases (140/156) succeeded in one successful puncture, and the successful puncture was successful in 16 cases after the first puncture failed. No case of abdominal bleeding, biliary peritonitis and other complications. The drainage effect of this group is better, poisoning crisis relief, jaundice decreased, liver function improved. Conclusions Compared with surgical operation, PTCD is simple, rapid, and minimally invasive. It is feasible and effective for emergency treatment of elderly patients with severe comorbidities and complicated diseases that can not tolerate surgery and anesthesia. The implementation of radical surgery for the fight for time.