經皮穿肝膽道引流術（PTCD）引流管移位與呼吸深度的關係

Relationship between Catheter Displacement and Depth of Respiration in Percutaneous Transhepatic Cholangiography and Drainage

本研究探討經皮穿肝膽道引流術（PTCD, Percutaneous Transhepatic Cholangiography and Drainage）引流管在無外力拉扯下引起位移是否與施行過程中，病人呼吸深度有關。2005年1月至2020年12月期間，某區域級教學醫院總共有492位患者因膽道阻塞接受PTCD治療納入本研究。病患由右側肝內膽管置入引流管，並且以實驗室檢驗數值評估病患臨床狀況，以及膽道攝影評估引流管功能及位置。納入研究對象中有17.07%（84/492）的病患之引流管出現不等程度的滑移。施行PTCD時，病患吸氣時橫膈下降程度愈大，引流管移位比率愈高；而未閉氣組之引流管移位的機率最低，只佔所有移位病患的7.14%（6/84）。
經由本篇研究顯示，病患呼吸程度愈平和，PTCD引流管滑脫機率愈低。因此，在不要求病患閉氣情形下，使用超音波導引配合病患呼吸節奏施行PTCD，可減少引流管滑脫機率；此外，使用帶線引流管並將管子末端成型（looping），將引流管盡量置於近端膽道，可增加引流管的固定性。

This study investigates whether catheter displacement without external pulling affects the depth of a patient’s respiration during percutaneous transhepatic cholangiography and drainage (PTCD). In this study, a total of 492 patients who underwent PTCD for bile duct obstruction in a regional teaching hospital from January 2005 to December 2020 were examined. The patients had drainage catheters inserted into their bile ducts on the right-hand side of the liver. Laboratory data were used to evaluate their clinical conditions, and cholangiograms were used to assess the functionality and positions of the catheters. Varying levels of catheter displacement were detected in 17.07% (84/492) of the patients. During the PTCD procedure, the greater the distance that a patient’s diaphragm moved during respiration, the more likely the catheter was to be displaced. Among patients with displaced catheters, only 7.14% (6/84) did not hold their breaths. In conclusion, patients who breathe gently are less likely to experience PTCD catheter displacement than those who do not. Therefore, patients should not be asked to hold their breaths during PTCD procedures, and ultrasound should be used to perform PTCD in coordination with the patient’s respiration to reduce the likelihood of catheter displacement. Furthermore, stringed catheters with looped ends should be inserted as close as possible to the bile duct to improve catheter stability.