| 摘要: |
| 目的 评价超声引导下经皮肝穿刺胆管引流（PTCD）与内镜逆行胰胆管造影（ERCP）会师术的临床应用价值。方法 选取我院常规行ERCP治疗困难或失败患者17例，应用超声引导下PTCD与ERCP会师术完成诊断及治疗操作，观察并比较术前及术后2天血白细胞、胆红素、转氨酶及血淀粉酶结果。结果 17例患者均成功完成PTCD-ERCP会师治疗，其中采取右侧肝内胆管穿刺16例，左侧肝内胆管1例；对胆总管结石患者行内镜下取石和鼻胆管放置，对胆道梗阻或狭窄患者行胆管扩张及支架置入术。术后17例患者的临床症状及实验室指标均较术前明显改善，胆道梗阻完全解除，均无严重并发症发生。结论 超声引导下PTCD与ERCP会师术成功率高、安全性好，具有广泛的临床应用价值。 |
| 关键词: 超声引导,PTCD,ERCP |
| DOI： |
| 投稿时间：2023-06-12修订日期：2023-12-06 |
| 基金项目:湖北省自然科学基金一般面上项目(编号：2022CFB225) |
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| Clinical application of ultrasound guided PTCD-ERCP combination |
| Yi Huiming,Tang Dachuan,Wang Bing,Zhang Jian,Zhang Wei |
| () |
| Abstract: |
| ABSTRACT Objective To evaluate the practical application of ultrasound guided percutaneous transhepatic cholangiography drainage（PTCD） combined with endoscopic cholangiopancreatography（ERCP） in patients with difficult ERCP.Methods From October 2020 to December 2022，ultrasound-guided PTCD combined with ERCP was performed in patients who had difficult or failed conventional ERCP treatment.The diagnostic and therapeutic procedures of ERCP were successfully completed. The blood white blood cells, bilirubin, transaminases, and amylase between pre- and 2 days post PTCD-ERCP combination were analyzed.Results The present study included 17 patients with difficult ERCP，including 3 cases of extrahepatic bile duct stones，7 cases of ampullary carcinoma，4 cases of pancreatic head cancer，1 case of biliary anastomotic stricture and calculus，2 cases of bile duct stricture post liver transplantation，PTCD-ERCP combination was successfully performed in each patient.Patients with common bile duct stones underwent endoscopic stone removal and nasobiliary drainage，while those with biliary obstruction underwent biliary dilation and stent placement.The clinical symptoms and laboratory indicators of all 17 patients improved significantly after the procedure，and no severe complications occurred.Ultrasound-guided PTCD combined with ERCP can improve the success rate of ERCP operation，and is suitable for minimally invasive management of biliary diseases in some patients with liver transplantation and rerouting of gastrointestinal tract.Conclusion Ultrasound-guided PTCD combined with ERCP is a highly successful and safe procedure with broad clinical utility. |
| Key words: Ultrasound-guided, PTCD, ERCP |
