CAJ | 학술논문

目的比较分析超声与X线引导内镜胆道引流术的置管成功率、疗效及手术并发症.方法比较62例超声引导内镜胆道引流术(超声引导组)和54例X线引导内镜胆道引流术(X线引导组)患者手术前后血清胆红素、胆总管内径和临床症状的变化情况.结果超声引导组62例中54例置管成功,手术前与术后1周患者血清直接胆红素分别为(205.41±115.27)μmol/L及(106.47±82.16)μmol/L(P<0.05),胆总管内径分别为(12.6±7.1)mm及(8.5±3.1)mm(P<0.05).X线引导组54例中51例置管成功,手术前与术后1周患者血清直接胆红素分别为(211.14±106.25)μmol/L及(110.89±59.47)μmol/L(P<0.05),胆总管内径分别为(13.1±7.0)mm及(8.8±3.2)mm(P<0.05).超声引导组术后无腹痛、发热、淀粉酶升高等早期并发症,X线引导组术后有3例(5.9%)出现上述并发症.结论 X线仍然是内镜胆道引流术最有效的引导方法.超声引导可避免X线辐射、造影剂过敏等不利因素,且具有实时显示、移动方便,可进行床边急诊、内镜下诊治等优点,可替代X线用于引导所有胆道结石以及狭窄不甚严重的肿瘤患者行鼻胆管引流术和胆道塑料支架引流术.
목적 비교분석초성여X선인도내경담도인류술적치관성공솔、료효급수술병발증.방법 비교62례초성인도내경담도인류술(초성인도조)화54례X선인도내경담도인류술(X선인도조)환자수술전후혈청담홍소、담총관내경화림상증상적변화정황.결과 초성인도조62례중54례치관성공,수술전여술후1주환자혈청직접담홍소분별위(205.41±115.27)μmol/L급(106.47±82.16)μmol/L(P<0.05),담총관내경분별위(12.6±7.1)mm급(8.5±3.1)mm(P<0.05).X선인도조54례중51례치관성공,수술전여술후1주환자혈청직접담홍소분별위(211.14±106.25)μmol/L급(110.89±59.47)μmol/L(P<0.05),담총관내경분별위(13.1±7.0)mm급(8.8±3.2)mm(P<0.05).초성인도조술후무복통、발열、정분매승고등조기병발증,X선인도조술후유3례(5.9%)출현상술병발증.결론 X선잉연시내경담도인류술최유효적인도방법.초성인도가피면X선복사、조영제과민등불리인소,차구유실시현시、이동방편,가진행상변급진、내경하진치등우점,가체대X선용우인도소유담도결석이급협착불심엄중적종류환자행비담관인류술화담도소료지가인류술.
Objective To compare the successful ratio, efficacy and complications between ultrasound-guided and X-ray-guided endoscopic biliary drainage (EBD). Methods EBD was performed in 62 patients under ultrasound guidance and 54 patients under X-ray guidance. Serum bilirubin, the bile duct diameter and the changes of clinical symptoms were compared before and after the procedure. Results Tube placement was successfully achieved in 54 of 62 patients under ultrasound guidance and 51 of 54 patients under X-ray guidance. The serum direct bilirubin and the common bile duct diameter in patients with ultrasound guidance before and one week after procedure were (205.41±115.27) μmol/L vs. (106.47±82.16) μmol/L and (12.6±7.1) mm vs. (8.5±3.1) mm, respectively, with significant difference (all P values<0.05). Whereas they were (211.14±106.25) μmol/L vs. (110.89±59.47) μmol/L and (13.1±7.0) mm vs. (8.8± 3.2) mm, respectively, in patients with X-ray guidance (P<0.05). No complications such as abdominal pain, fever and elevated amylase were found in patients with ultrasound guidance, while 3 patients (5.9%) with X-ray guidence had above complications. Conclusions X-ray is a most effective method in guidance of EBD. However, ultrasound guidence, which may avoid unfavorable factors such as X-ray radiation and allergic contrast agent, has some advantages including real-time display, mobile convenience and emergency bedside application. It can instead of X-ray in performance of endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage in patients with bile duct stone and mild narrow ducl caused by tumors.