經皮穿肝膽管排液法

PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE

邱文德(Man-Tak Yau)

《中華放射線醫學雜誌》 8卷3期 (1983/09) Pp. 205-212

摘要

經皮穿肝膽管排液法(Percutaneous Biliary Drainage)，簡稱PBD，對於阻塞性黃膽之治療價值是無可置疑的。43例施行PBD者有40例成功，成功率達93%；手術後血清膽紅素回復正常者9例(22.5%)，下降大於10mg/dl者約半數。術後嚴重併發症有2例，其中1例死亡。因長期使用姑息性排液而發生膽管炎者共10例(25%)。併發病之發生，右脇腹側處理比前側處理之發生率稍高。又利用超音波掃描導引經前側處理由左肝管置入引流管之排液法可減少手術之時間及併發病之發生。

並列摘要

The mortality as well as the morbidity in patients with obstructive jaundice rise approximately proportionally to the patients' serum bilirubin level. To prevent liver damage, the biliary ducts should be decompressed as early as possible even if the patients' condition is poor. One simple and effective method, carrying less risk than laparotomy, is percutaneous transhepatic biliary drainage. The advantages of percutaneous transhepatic biliary drainage as a palliative procedure in inoperable patients with obstructive jaundice are well documented. In patients with elevated bilirubin level, preoperative precutaneous bile drainage is a good alternative to the implantation of a T-tube at laparotomy. A total of 43 cases of percutaneous transhepatic biliary drainage were performed from April 1981 to May 1983. The overall success rate was 93%. 9 cases were noted to resume normal bilirubin level after the procedure while bilirubin declined greater than 10 mg in half the cases. The overall incidence of serious complication with PBD was 5%. Cholangitis which occurred in 10 patients (25%) usually followed catheter occlusion or dislodgement. We compared different methods of performing percutaneous transhepatic biliary drainage and concluded that the complication rate using the anterior approach method, especially under sonographic guidance was significantly lower than using the lateral approach method. Finally, it should be emphasized that the low complication rate and high success rate make PBD preferable to operative decompression for obstructive jaundice.