CAJ | 학술논문

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 ～400 ml,所有患者24h内一般情况改善,48 h后胆红素下降约25～ 100 μmol/L.3例血小板数量＜20×109/L的患者引流72 h后血小板回升至＞50×109/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＞ 200 μmol/L的患者长期带管.手术前带管时间7d～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.
목적 탐토경피경간담관인류(PTCD)재결석소치간내경조성중증담관염(ACST)치료중적림상개치.방법 회고성분석2009년12월지2013년1월수치적8례PTCD후재행수술적간내경조형ACST환자적림상자료.결과 8례환자균재X선인도하성공진행PTCD.당일인류담즙100 ～400 ml,소유환자24h내일반정황개선,48 h후담홍소하강약25～ 100 μmol/L.3례혈소판수량＜20×109/L적환자인류72 h후혈소판회승지＞50×109/L.소유환자균성공접수수술,기중2례환자행담도탐사+T관인류술,2례환자동시행좌반간절제,3례행담장문합술.8례중7례전유,1례간공능쇠갈、담홍소지속＞ 200 μmol/L적환자장기대관.수술전대관시간7d～3개월,PTCD관균보지통창,무사망급출혈、담루、복막염등엄중병발증발생.결론 PTCD용우치료간내경조형ACST성공솔교고,창상소,내수성호,인류효과가고,능충분강저담도압력,강저수술풍험,위수술창조료궤회화조건.
Objective To study the safety and efficacy of damage control using percutaneous transhepatic biliary drainage (PTBD) in acute cholangitis of severe type (ACST) secondary to intrahepatic choledocholithiasis.Methods The clinical data of 8 patients who received PTBD after hospital admission followed by conventional surgery for ACST when their general condition improved were retrospectively studied.Results All patients received PTBD successfully and the amount of bile drained was 100-400 ml in the first day.The general condition of these 8 patients became better after 24 h and the total bilirubin decreased for about 25-100 mmol/L after 48 h.Three patients with a platelet count of less than 20 × 109/L showed an improved count to more than 50 × 109/L 72 h after PTBD.All patients were operated at different times after the PTBD:2 received T-tube drainage,3 T-tube drainage combined with left hepatectomy,and 3 choledochojejunostomy.Seven patients recovered uneventfully,but 1 developed hepatic failure with the total billurubin rose to more than 200 μmol/L.He was discharged home with the PTBD tube.During the waiting time of 7 days to 3 months before surgery,the tubes were kept patent and no mortality or morbidity such as bleeding,bile leakage,and peritonitis occurred.Conclusions PTBD was a safe and efficacious procedure for patients who were in a serious condition with ACST secondary to intrahepatic choledocholithiasis.It was more likely to be successful as it is minimally invasive and therefore well-tolerented.It reduced the biliary pressure,relieved the ongoing sepsis,and was a good preparatory procedure before any conventional surgery.