XperCT-assisted PTCD For Accurate Treatment Of Malignant

Purpose:To explore the clinical application value in using XperCT technology to improve the accuracy in percutaneous transhepatic biliary drainage(PTCD)of malignant obstructive jaundice.Methods:Eighty-seven cases of malignant obstructive jaundice from October 2018 to October2019 in our hospital were selected.Eighty-seven patients were divided into two groups according to the random number table method.Group A(42 cases)of study group applied XperCT examination in PTCD,scanned XperCT before operation,planned puncture path and puncture point after image reconstruction,and punctured according to the direction and distance guided by the path to guide the specific implementation of PTCD.The control group B(45 cases)did not undergo XperCT examination during PTCD,and was located and punctured under conventional X-ray fluoroscopy.The research method is to provide one or more of the following available information to help the surgeon to make preoperative judgment by applying XperCT to reconstruct the image before operation: 1.It can accurately and rapidly determine the puncture point and accurately avoid intrahepatic blood vessels or intrahepatic space occupying lesions,lung bottom and intestinal canal,etc.However,conventional PTCD requires fluoroscopy of the intercostal space and puncture point,which makes it difficult to avoid intrahepatic lesions.2.Determine the puncture direction and depth.After multi-angle analysis by XperCT scanning reconstruction before operation,design the puncture path according to the pathological changes.Adjust the direction of the C-arm detector to be perpendicular to the puncture direction through laser navigation,or puncture with real-time navigation technology.However,conventional PTCD requires puncture toward the thoracic 11 vertebral body,and the needle insertion is stopped at about 2cm from the vertebral body.3.Quickly and accurately determine the target bile duct to be punctured,especially for the determination of grade 3 and grade 4 branch bile ducts.Puncture using branch bile duct can effectively reduce the complications of puncture.However,conventional PTCD is an empirical puncture and has no strong purpose.T-test of independent samples was used to compare the difference in puncture time and exposure dose between the two groups.The c2-tests were used to compare the two groups in the success rate of the first puncture of the target bile duct(the segmental bile duct to be punctured before the operation,preferably the three or four-stage branch bile duct),the success rate of avoiding important tissues and organs(including intrahepatic space occupation,lung base,intestine,etc.),the success rate of puncture times and the incidence of postoperativecomplications(bleeding,bile fistula,pancreatitis,infection,etc.).P < 0.05 with statistical difference.Results:Successful puncture in both groups.The success rate of the first puncture of the target bile duct was 88% in group A,51% in group B,P < 0.05;the success rate of avoiding important tissues and organs was 95% in group A,78% in group B(one patient died of massive hemorrhage of puncture tumor),c2 = 0.018,P = 0.018;the puncture time was(14.02± 3.23)s in group A,63.20 ± 6.22 s in group B,and the exposure radiation dose was(6.21 ±1.35)in group A MGy and group B(21.33 ± 7.38)mGy,the success rate of puncture times was c 2 = 17.606,P = 0.001,with statistical significance.The incidence of postoperative complications(bleeding,infection,bile fistula,pancreatitis,etc.)wasc2 = 4.567,P = 0.033,which was statistically significant.Group A was better than group B,P < 0.05,with statistical difference.Conclusions:The application of XperCT in PTCD can make up for the deficiency of single perspective,guide interventional physicians to implement accurate treatment from different angles,reduce the incidence of serious complications,and ultimately improve the therapeutic effect of PTCD.