超声定位导向经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的临床研究

The clinical effect of ultrasound positioning guided PTCD in the treatment of malignant obstructive jaundice and its influence on patients’ liver function

目的:观察经皮肝穿刺胆道引流术(PTCD)在超声定位导向下治疗恶性梗阻性黄疸(MOJ)的临床效果及对患者肝功能的影响。方法:选取2018年1月至2021年1月本院诊治的MOJ患者134例作为研究对象,以随机数字表法分为A组(n=67)和B组(n=67),其中A组患者采用常规导向下PTCD治疗,B组患者采用超声定位导向下PTCD治疗,比较两组患者相关手术指标、肝功能指标及临床效果。结果:A组患者手术时间长于B组,穿刺次数多于B组,有效带管时间短于B组(P<0.05);两组患者术后胆汁引流量比较,差异无统计学意义(P>0.05)。两组患者术后天门冬氨酸氨基转移酶(AST)、丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GCT)、总胆红素(TBil)水平均下降(P<0.05),两组间比较,差异无统计学意义(P>0.05);两组患者术后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均明显升高,且B组高于A组(P<0.05);两组患者术后CD8^(+)均明显降低(P<0.05),组间比较,差异无统计学意义(P>0.05)。两组患者总有效率比较,差异无统计学意义(P>0.05),B组患者并发症发生率7.46%,低于A组16.42%(P<0.05);随访发现,B组患者3年生存率为64.18%(43/67),高于A组46.27%(31/67),差异有统计学意义。结论:超声定位导向下PTCD治疗MOJ患者可缩短手术时间,在一定程度上改善患者细胞免疫功能并促进肝功能恢复,延长患者生存时间,安全性高。

Objective:To determine the clinical effect of percutaneous transhepatic biliary drainage (PTCD) in the treatment of malignant obstructive jaundice (MOJ) under the guidance of ultrasound positioning and its influence on the liver function of patients.Methods:We se-lected 134 MOJ patients accepted by our hospital from January 2018 to January 2021 as the research objects,and divided them into group A(n=67) and group B (n=67) by random number table method,of which group A patients were treated with PTCD under conventional guid-ance,and patients in group B were treated with PTCD under ultrasound positioning guidance.The relevant surgical indicators,liver function indicators,and clinical effects of the two groups were compared.Results:The operation time of group A was longer than that of group B,the number of punctures was more than that of group B,and the effective catheterization time was shorter than that of group B (P<0.05),there was no statistically significant difference in the amount of bile drainage between the two groups of patients after surgery (P>0.05).Postop-eratively,aspartate aminotransferase (AST),alanine aminotransferase (ALT),glutamyl transpeptidase (GCT),and total bilirubin (TBL)levels decreased (P<0.05),but both there was no statistically significant difference between the groups (P>0.05),the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the two groups after surgery were significantly increased,and the levels in group B were higher than those in group A(P<0.05).CD8^(+)in the two groups after surgery both were significantly reduced (P<0.05),but the difference between the two groups was not statistically significant (P>0.05).There was no statistically significant difference in the total effective rate between the two groups(P>0.05).The complication rate in group B was 7.46%,which was lower than 16.42%in group A (P<0.05),follow-up found that the three-year survival rate of patients in group B was 64.18%(43/67),46.27%(31/67) higher than group A,the difference was statistically significant(χ^(2)=4.346,P=0.037).Conclusion:Ultrasound positioning-guided PTCD treatment of MOJ patients can shorten the operation time,improve the patient’s cellular immune function,and promote the recovery of liver function to a certain extent,extend the patient’s sur-vival time,and have high safety.