目的：探讨超声定位联合X 线引导下经皮经肝穿刺胆管引流术（PTCD）治疗恶性梗阻性黄疸的临床效果。方法：回顾性分析行超声联合X线引导下PTCD术的46例恶性梗阻性黄疸患者资料。结果：44例（95.65%）PTCD成功，其中41例（93.2%）1次穿刺置管成功，3例（6.81%）经2次穿刺置管成功。术后引流量100~800 mL/d，术后第1天开始，患者黄疸均开始不同程度改善，临床症状逐渐减轻。术后1周，患者血清总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、碱性磷酸酶水平 均较术前明显降低（均P<0.05）。术后出现胆道感染2例，出现少量胆道出血3例，均经对症治疗后恢复，无其他严重并发症发生。结论：超声定位联合X线引导下行PTCD 具有安全、简便、并发症少的优点，是一种治疗恶性梗阻性黄疸的有效方法。
Percutaneous transhepatic cholangiodrainage under ultrasonic and X-ray guidance for malignant obstructive jaundice
Objective: To assess the clinical efficacy of percutaneous transhepatic cholangiodrainage (PTCD) under ultrasonic and X-ray guidance in management of malignant obstructive jaundice. Methods: The data of 46 patients with malignant obstructive jaundice undergoing PTCD under combined ultrasonic and X-ray guidance were retrospectively analyzed. Results: PTCD was successfully performed in 44 patients (95.65%), of whom, puncture and catheter introduction was completed in one session in 41 cases (93.2%), and in two sessions in 3 cases (6.81%). The daily postoperative drainage volume was 100-800 mL, and from the first day after PTCD, the jaundice of the patients began to show regression in varying degrees and their symptoms were gradually alleviated. At one week after PTCD, the serum levels of total bilirubin, direct bilirubin, alanine transaminase, aspartate transaminase and alkaline phosphatase of the patients were all decreased significantly compared with their preoperative values (all P<0.05). Biliary tract infection occurred in 2 cases and slight bleeding of the biliary tract occurred in 3 cases after PTCD, which were resolved by symptomatic treatments, and no other serious complications occurred. Conclusion: PTCD under combined ultrasonic and X-ray guidance has the advantages of being safe and convenient with few complications, and is an effective treatment method for malignant obstructive jaundice.