经皮经肝胆管引流在肝内梗阻性重症胆管炎损伤控制中的临床价值.pdf

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1、中华肝胆外科杂志2014年2月第2O卷第2期ChinJHepatobiliarvSurK，February2014Vo1．20．No．2·1O1-·论著·经皮经肝胆管引流在肝内梗阻性重症胆管炎损伤控制中的临床价值吴武军杜立学杨俊武何凯亮孙华刘晓刚胡海田【摘要】目的探讨经皮经肝胆管引流(PTCD)在结石所致肝内梗阻性重症胆管炎(ACST)治疗中的临床价值。方法回顾性分析2009年12月至2013年1月收治的8例PTCD后再行手术的肝内梗阻型ACST患者的临床资料。结果8例患者均在x线引导下成功进行PTCD。当日引流胆汁100—400ml，所有患者24h内一般情

2、况改善，48h后胆红素下降约25～100p,mol／L。3例血小板数量<20×10／L的患者引流72h后血小板回升至>50×10／L。所有患者均成功接受手术，其中2例患者行胆道探查+T管引流术，2例患者同时行左半肝切除，3例行胆肠吻合术。8例中7例痊愈，1例肝功能衰竭、胆红素持续>200I~mol／L的患者长期带管。手术前带管时间7d一3个月，PTCD管均保持通畅，无死亡及出血、胆漏、腹膜炎等严重并发症发生。结论PTCD用于治疗肝内梗阻型ACST成功率较高，创伤小，耐受性好，引流效果可靠，能充分降低胆道压力，降低手术风险，为手术创造了机会和条件。【关键词】胆

3、管炎；引流术；消化系统外科手术DamagecontrolusingpercutaneoustranshepaticbiliarydrainageinacutecholangitisofseveretypesecondarytointrahepaticcholedocholithiasisWuWujun，DuLixue，ynngJunwu，Kailiang，SunHua，LiuXiaogang，HuHaitian．DepartmentofHepatobiliarySurgery，ShaanxiProvincialPeople’Hospi—ta1．Xi’6／7,

4、710068．inaCorrespondingauthor：DuLixue。Emial：fueduxa@163．con【Abstract】0bjectiveTostudythesafe~andeficacyofdamagecontrolusingpercutaneoustran—shepaticbiliarydrainage(fyrBD)inacutecholangitisofseveretype(ACST)secondarytointrahepaticcho—ledocholithiasis．MethodsTheclinicaldataof8patient

5、swhoreceivedBDafterhospitaladmissionfo1．1owedbyconventionalsurgeryforACSTwhentheirgeneralconditionimprovedwereretrospectivelystudied．ResultsA11patientsreceivedBDsuccessfullyandtheamountofbiledrainedwas100—400mlinthefirstday．Thegeneralconditionofthese8patientsbecamebetterafter24hand

6、thetotalbilirubindecreasedf0rabout25—100mm0L／Lafter48h．Threepatientswithaplateletcountoflessthan20×10／Lshowedanimprovedcounttomorethan50×10／L72hafterBD．A11patientswereoperatedatdifferenttimesaftertIleBD：2receivedT．tubedrainage．3T—tubedrainagecombinedwithlefthepatectomy．and3choledo．

7、chojejunostomy．Sevenpatientsrecovereduneventfully．but1developedhepaticfailurewitllthetotalbillurubinrosetomorethan200LLmoL／L．HewasdischargedhomewiththePrI1BDtube．Duringthewaitingtimeof7daysto3monthsbeforesurgery，thetubeswerekeptpatentandnomortalityormorbiditysuchasbleeding．bileleak

8、age．andperitonitisoccurred