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目的探讨细针微导丝一步穿刺法置粗管经皮肝胆道引流的应用价值。方法37例阻塞性黄疸病人,恶性梗阻31例,良性梗阻6例。使用微穿刺套,经腋中线或剑突下入路。22G针进入胆管后造影,引入微导丝并扩张后置5F导管,利用超滑导丝越过阻塞后换入硬导丝,扩张器及球囊扩张,导入12F根据需要剪出侧孔的引流管。结果34例置管成功,其中3例置入双管。建立内-外引流28例,外引流6例。术后胆道出血2例。5例引流管移位或脱落须重新放置。结论细针微导丝法置管可避免再用套管针穿刺造成肝脏损伤。球囊法扩张有助于即时置入大腔引流管。
Objective To investigate the value of fine-needle micro-guide wire percutaneous puncture for percutaneous transhepatic biliary drainage by one-step puncture. Methods 37 patients with obstructive jaundice, malignant obstruction in 31 cases, benign obstruction in 6 cases. Using a micro-puncture sleeve, the axillary midline or xiphoid approach. 22G needle into the bile duct after angiography, the introduction of micro-guide wire and expansion of post-5F catheter, the use of ultra-smooth guide wire over the block into the hard guide wire, dilator and balloon dilatation, into the 12F according to the need to cut out the side hole of the drainage tube . Results 34 cases of successful catheterization, of which 3 were placed double tube. Establishment of internal - external drainage in 28 cases, 6 cases of external drainage. Biliary hemorrhage in 2 cases. 5 cases of drainage tube displacement or off to be re-placed. Conclusion Fine-needle micro-guidewire cannulation can avoid the need of trocar puncture to cause liver damage. Balloon expansion helps to instantly insert a large cavity drainage tube.