Objective: To analyze the clinical application value of a novel magnetic navigation ultrasound (MNU) combined with digital subtraction angiography (DSA) dual-guided percutaneous transhepatic biliary drainage (PTCD) through the right hepatic duct for the treatment of malignant obstructive jaundice. Methods: Randomized controlled trial. The clinical data of 64 patients with malignant obstructive jaundice requiring PTCD through the right hepatic duct at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People's Hospital) from December 2018 to December 2021 were retrospectively analyzed. The MNU group (n=32) underwent puncture guided by a novel domestic MNU combined with DSA, and the control group (n=32) underwent puncture guided by traditional DSA. The operation time, number of punctures, X-ray dose after biliary stenting as shown by DSA, patients' tolerance of the operation, success rate of the operation, pre- and post-operative total bilirubin, and incidence of postoperative complications were compared between the two groups. Results: The operation time of the MNU group was significantly shorter than that of the control group [(17.8±7.3) vs. (31.6±9.9) min, t=-6.35,P=0.001]; the number of punctures in the MNU group was significantly lower [(1.7±0.6) vs. (6.3±3.9) times, t=-6.59, P=0.001]; and the X-ray dose after biliary stenting as shown by DSA in the MNU group was lower than that in the control group [(132±88) vs. (746±187) mGy, t=-16.81,P<0.001]; Five patients in the control group were unable to tolerate the operation, and two stopped the operation, however all patients in the MNU group could tolerate the operation, and all completed the operation, with a success rate of 100% (32/32) in the MNU group compared to 93.8%(30/32) in the control group; the common complications of PTCD were biliary bleeding and infection, and the incidence of biliary bleeding (25.0%, 8/32) and infection (18.8%, 6/32) in the MNU group was significantly lower than that in the control group, 53.1% (17/32) and 28.1% (9/32), respectively. Conclusion: Magnetic navigation ultrasound combined with DSA dual-guided PTCD through the right biliary system for the treatment of malignant obstructive jaundice is safe and feasible.
目的： 探讨一款新型磁导航超声技术联合数字减影血管造影（DSA）双引导经右肝管行经皮肝穿刺胆管引流术（PTCD）治疗恶性梗阻性黄疸的初步临床应用价值。 方法： 随机对照试验。回顾性分析南京医科大学第一附属医院（江苏省人民医院）肝胆中心2018年12月至2021年12月收治的64例因恶性梗阻性黄疸需从右肝管行PTCD的患者的临床资料，磁导航超声组患者为32例，采用新型磁导航超声（MNU）结合DSA进行双引导穿刺，对照组患者为32例，采用传统DSA引导进行穿刺。对比两组的手术时间、穿刺次数、胆管置管完成后DSA显示的X线剂量、患者对手术的耐受度、手术成功率、手术前后总胆红素及术后并发症发生率等情况。 结果： 磁导航超声组手术时间明显短于对照组［（17.8±7.3）比（31.6±9.9）min，t=-6.35，P=0.001］。穿刺次数磁导航超声组明显减少［（1.7±0.6）比（6.3±3.9）次，t=-6.59，P=0.001］。胆管置管完成后DSA显示的X线剂量磁导航超声组少于对照组［（132±88）比（746±187）mGy，t=-16.81，P<0.001］。对照组有5例患者表示，因多次穿刺引发的疼痛或长时间的手术无法承受相关手术操作，2例因此停止手术，而磁导航超声组没有患者出现无法耐受手术的情况，全部完成手术，手术成功率磁导航超声组（100%，32/32）高于对照组（93.8%，30/32）。磁导航超声组患者胆管出血（25.0%，8/32）及感染的发生率（18.8%，6/32）明显低于对照组，对照组出血发生率53.1%（17/32）、感染发生率28.1%（9/32）。 结论： 新型磁导航超声结合DSA双引导经右胆管行PTCD治疗恶性梗阻性黄疸安全、有效，具有较高的临床推广价值。.