超声引导下胆道系统引流管更换技术的应用分析

张安红; 张瑞昕; 马杰; 邱博; 伊鑫; 鲁志华; 郑立杰; 董汉光; 韩田; 张丽; 姜远辉; 徐钧

doi:10.3969/j.issn.1001-5256.2022.11.020

超声引导下胆道系统引流管更换技术的应用分析

DOI: 10.3969/j.issn.1001-5256.2022.11.020

张安红^{1, 2},
张瑞昕^3a,
马杰²,
邱博²,
伊鑫²,
鲁志华²,
郑立杰²,
董汉光²,
韩田^3b,
张丽¹,
姜远辉^2, , ,,
徐钧^1, , ,

1.
山西医科大学第一医院肝胆胰外科及肝脏移植中心，太原 030000
2.
山东大学齐鲁医院普外科，山东青岛 266035
3a.
山西医科大学基础医学院，太原 030000
3b.
山西医科大学第一临床医学院，太原 030000

基金项目:

山西省科学技术厅中央引导地方专项 (YDZJSX2021B012)

伦理学声明：本研究方案于2020年11月5日经由山东大学齐鲁医院伦理委员会审批，批号：KYLL-qdql2020083。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：张安红、马杰、邱博、伊鑫负责数据的收集及总结；张瑞昕、鲁志华、郑立杰、董汉光负责论文撰写；韩田、张丽负责数据的分析；姜远辉、徐钧负责指导写作及最终定稿。

详细信息

通信作者:
姜远辉，jyh2@sina.com

徐钧，junxuty@163.com

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出版历程
- 收稿日期: 2022-04-10
- 录用日期: 2022-05-30
- 出版日期: 2022-11-20

Application and clinical evaluation of ultrasound-guided biliary drainage tube replacement technology

Anhong ZHANG^{1, 2},
Ruixin ZHANG^3a,
jie MA²,
Bo QIU²,
Xin YI²,
Zhihua LU²,
Lijie ZHENG²,
Hanguang DONG²,
Tian HAN^3b,
Li ZHANG¹,
Yuanhui JIANG^{2
, ,
,},
Jun XU^{1
, ,
,}

1.
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplant Center, The First Hospital of Shanxi Medical University, Taiyuan 030000, China
2.
Department of General Surgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, China
3a.
School of Basic Medicine, Shanxi Medical University, Taiyuan 030000, China
3b.
The First Clinical Medical College, Shanxi Medical University, Taiyuan 030000, China

Research funding:

Local Special Projects Guided by the Central Government of Shanxi Province (YDZJSX2021B012)

More Information

Corresponding author: JIANG Yuanhui, jyh2@sina.com (ORCID: 0000-0002-1102-3481); XU Jun, junxuty@163.com (ORCID: 0000-0003-3755-9660)

摘要

摘要: 目的总结超声引导下胆道系统引流管更换的初步应用结果，提出相应的技术要点，探讨操作策略及临床应用价值。方法采用回顾性分析方法收集2014年8月—2020年8月山东大学齐鲁医院收治的60例通过超声引导下进行胆道系统引流管更换的患者的临床资料，对操作过程以及术后并发症进行分析，对操作技术和临床应用进行总结。结果 60例患者中，沿原窦道成功完成引流管更换58例，成功率96.67%，其中扩张窦道置入粗级别引流管47例，置入原型号引流管11例。平均操作时间为15.8(12.0~19.0)min，需用局部麻醉剂。28例为PTCD引流，23例为胆囊引流，9例为T管引流，均引流胆汁。术后观察引流情况，均较前好转，有效率100%，术后回访未见明显异常。结论超声引导下引流管更换简便、安全、可行，为其在临床中进一步推广提供了数据支持。
- 超声检查, 介入性 /
- 胆道外科手术 /
- 引流术 /
- 穿刺术 /
- 引流管
Abstract: Objective To summarize the preliminary application results of ultrasound-guided biliary drainage tube replacement, present the corresponding technical points, and discuss the operation strategy and clinical application value. Methods The clinical data of 60 patients who underwent ultrasound-guided biliary drainage tube replacement in Qilu Hospital of Shandong University between August 2014 and August 2020 were retrospectively analyzed. The operation procedure, clinical applications, and postoperative complications were summarized and analyzed. Results Fifty-eight of the 60 patients (96.67%) were successfully replaced with drainage tubes along the original sinus. Among them, dilated sinus tracts of 47 patients were placed with coarse-grade drainage tubes, and dilated sinus tracts of the remaining 11 patients were placed with the original type of drainage tubes, with the mean operation time of 15.8(12.0-19.0) min under local anesthesia. In total, bile was drained from 28 patients receiving PTCD drainage, 23 patients receiving gallbladder drainage, and 9 patients receiving T-tube drainage. The post-operation evaluation revealed that the drainage situation has improved, with a 100% effective rate. No obvious abnormality was found in the postoperative follow-up visit. Conclusion The replacement of drainage tube under ultrasound guidance is simple, safe and feasible, and it provides further promotion in clinical practice with sufficient data support.
- Ultrasonography, Interventional /
- Biliary Tract Surgical Procedures /
- Drainage /
- Punctures /
- Drainage Tube

HTML全文

图 1 超声引导下引流管位置

注：a，沿原引流管注入盐水，确认引流管位置，箭头为引流管头端位置；b，胆管内可见引流管影像，箭头为引流管；c，沿原引流管置入导丝，箭头为导丝头端位置。

Figure 1. Ultrasound-guided drainage tube placement

下载: 全尺寸图片幻灯片

图 2 超声引导下引流管观察

注：a，沿新引流管注入少量盐水，箭头为引流管进入胆管位置；b，沿新引流管注入少量盐水，箭头为引流管头端位置。

Figure 2. Observation of drainage tube under ultrasound guidance

下载: 全尺寸图片幻灯片

参考文献(12)

[1]	YANG DX, ZHANG Y, WANG XF, et al. Application of ultrasound-guided real time percutaneous transhepatic cholangial or transhepatic cholecyst drainage in treatment of acute obstructive cholangitis in primary hospitals[J]. J Clin Hepatol, 2020, 36(4): 847-849. DOI: 10.3969/j.issn.1001-5256.2020.04.027. 杨东晓, 张勇, 王雪峰, 等. 超声实时引导下经皮经肝胆管或胆囊穿刺置管引流术治疗急性梗阻性胆管炎在基层医院的应用[J]. 临床肝胆病杂志, 2020, 36(4): 847-849. DOI: 10.3969/j.issn.1001-5256.2020.04.027.
[2]	HE YT, XIE LD, ZHOU HP, et al. Application of ultrasound-guided percutaneous transhepatic bile duct drainage in 100 cases[J]. Chin J Prim Med Pharm, 2019, 26(18): 2235-2238. DOI: 10.3760/cma.j.issn.1008-6706.2019.18.014. 何颖韬, 谢丽丹, 周海萍, 等. 超声引导经皮经肝穿刺胆管引流术100例应用观察[J]. 中国基层医药, 2019, 26(18): 2235-2238. DOI: 10.3760/cma.j.issn.1008-6706.2019.18.014.
[3]	GIURAZZA F, CORVINO F, CONTEGIACOMO A, et al. Safety and effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage: a multicenter experience[J]. J Ultrasound, 2019, 22(4): 437-445. DOI: 10.1007/s40477-019-00399-w.
[4]	ZHAO KY, ZHANG K, WANG S, et al. Advances in endoscopic ultrasound-guided gallbladder interventional therapy[J]. Chin J Med Offic, 2020, 48(12): 1503-1506. DOI: 10.16680/j.1671-3826.2020.12.44. 赵凯越, 张凯, 王晟, 等. 超声内镜引导下胆囊介入治疗研究进展[J]. 临床军医杂志, 2020, 48(12): 1503-1506. DOI: 10.16680/j.1671-3826.2020.12.44.
[5]	SUN WB. Preventive strategies of bile duct injury in emergent laparoscopic operations for severe acute cholecystitis[J]. Chin J Hepatobiliary Surg, 2016, 22(7): 433-436. DOI: 10.3760/cma.j.issn.1007-8118.2016.07.001. 孙文兵. 重度急性胆囊炎急诊腹腔镜手术时的胆管损伤的预防策略[J]. 中华肝胆外科杂志, 2016, 22(7): 433-436. DOI: 10.3760/cma.j.issn.1007-8118.2016.07.001.
[6]	LI CL, ZOU SH, YI GX, et al. Percutaneous transhepatic cholangiodrainage under ultrasonic and X-ray guidance for malignant obstructive jaundice[J]. Chin J Gen Surg, 2015, 24(2): 185-189. DOI: 10.3978/j.issn.1005-6947.2015.02.006. 李春雷, 邹盛海, 易广新, 等. 超声定位联合X线引导下经皮经肝穿刺胆管引流术治疗恶性梗阻性黄疸[J]. 中国普通外科杂志, 2015, 24(2): 185-189. DOI: 10.3978/j.issn.1005-6947.2015.02.006.
[7]	YU DJ, REN WZ, YUE ZY, et al. Ultrasound guided percutaneous transhepatic biliary drainage: an analysis of 479 patients[J]. Chin J Hepatobiliary Surg, 2018, 24(2): 83-86. DOI: 10.3760/cma.j.issn.1007-8118.2018.02.003. 于德江, 任为正, 岳振宇, 等. 超声引导下经皮肝内胆管穿刺置管引流479例分析[J]. 中华肝胆外科杂志, 2018, 24(2): 83-86. DOI: 10.3760/cma.j.issn.1007-8118.2018.02.003.
[8]	HAN JZ, TUO HF, WANG ZP, et al. Research advances in percutaneous cholecystostomy in treatment of acute cholecystitis[J]. J Clin Hepatol, 2021, 37(8): 1983-1987. DOI: 10.3969/j.issn. 1001-5256.2021.08.052. 韩景钊, 脱红芳, 王泽普, 等. 经皮胆囊造瘘术治疗急性胆囊炎的研究进展[J]. 临床肝胆病杂志, 2021, 37(8): 1983-1987. DOI: 10.3969/j.issn. 1001-5256.2021.08.052.
[9]	XIE F, ZHU F, WANG HY, et al. Clinical application of percutaneous gallbladder drainage in severe acute pancreatitis[J]. J China Med Univ, 2018, 3: 244-246. DOI: 10.12007/j.issn.0258-4646.2018.03.012. 谢锋, 朱芳, 王红岩, 等. 经皮胆囊穿刺引流术辅助治疗重症急性胰腺炎的临床应用价值[J]. 中国医科大学学报, 2018, 3: 244-246. DOI: 10.12007/j.issn.0258-4646.2018.03.012.
[10]	OGURA T, TAKAGI W, KURISU Y, et al. Technical tips for peroral transluminal cholangioscopy using novel single-operator cholangioscope (with videos)[J]. J Hepatobiliary Pancreat Sci, 2016, 23(10): E25-E29. DOI: 10.1002/jhbp.380.
[11]	BELAND MD, PATEL L, AHN SH, et al. Image-guided cholecystostomy tube placement: short- and long-term outcomes of transhepatic versus transperitoneal placement[J]. AJR Am J Roentgenol, 2019, 212(1): 201-204. DOI: 10.2214/AJR.18.19669.
[12]	GUPTA P, MARALAKUNTE M, KALRA N, et al. Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis[J]. Abdom Radiol (NY), 2021, 46(5): 2156-2160. DOI: 10.1007/s00261-020-02825-8.