目的

探讨超声导向下经皮肝穿胆管引流术（percutaneous transhepatic biliary drainage，PTBD）的入路选择策略。

方法

回顾性收集并分析225例梗阻性黄疸患者经皮肝穿胆管引流术前后的临床资料，其中左侧入路198例，右侧入路19例，左右两侧同时入路8例。

结果

超声导向下左、右侧入路穿刺均顺利完成；左侧入路置入的内外引流管随访期间均未出现非人为因素的脱出，右侧入路的外引流12例，有7例术后引流管有非人为因素脱出或明显移位；左侧入路术后穿刺局部疼痛不适在1～3 d内基本消失，右侧入路术后穿刺区域疼痛时间较长，并可出现呼吸幅度受限，多在3～7 d后症状缓解，少数患者不适症状可持续2～8周。

结论

超声导向下左右两侧入路均安全可行；引流效果相同的情况下，建议从左侧入路行PTBD，并发症较右侧入路少，患者生活质量更高。

Objective

The purpose of this study was to investigate the strategy of puncture approach in the ultrasound-guided percutaneous transhepatic biliary drainage（PTBD）producer.

Methods

We retrospectively analyzed the clinical data of 225 cases with obstructive jaundice treated with PTBD before and after the producers including the left side approach in 198 cases，the right side approach in 19 cases and the both side approach in 8 cases.

Results

The producers were successfully performed in the all patients with the guidance of the ultrasound.During the follow-up，there was no tube prolapse in the cases accepting left side approach，however，in the 12 cases with outside drainage by the right side approach，tube dislocation or shift occurred in 7 cases.The pain of the puncture site in the patients with left side approach gradually disappeared in 1 to 3 days，but the patients with right side approach suffered pain within longer time，and some patients had somewhat breathing amplitude limit which released in 3 to 7 days and lasted until 2 to 8 weeks in a few patients.

Conclusion

Ultrasound guided PTBD can be safely performed in both side approach.We recommend that the left side approach should be considered firstly in the PTBD producer because of less complications and higher quality of life.