PTBD与PTIBS治疗低位恶性梗阻性黄疸的效果观察

Effect of PTBD and ptibs on low malignant obstructive jaundice

目的分析经皮经肝胆汁引流术(percutaneous transhepatic biliary drainage,PTBD)及胆道支架植入术(percutaneous transheoatic insertion of biliary stent,PTIBS)治疗低位恶性梗阻性黄疸的效果。方法选择2019年6月~2021年6月院内低位恶性梗阻性黄疸患者共65例,所有患者均经影像学检查及病理检查确诊。梗阻原因包括胆管癌16例、壶腹癌12例、胆囊癌12例、十二指肠乳头癌15例、胰头癌10例。术中根据造影结果PTBD或PTIBS治疗。结果65例患者均完成手术,其中进行PTBD治疗共24例,PTIBS治疗共33例,PTBD联合PTIBS治疗共8例。总胆红素(Total bilirubin,TBIL)水平由术前(294.38±151.85)umol/L降低至术后(150.84±105.38)umol/L,差异有统计学意义(P<0.05);术后谷丙转氨酶(Alanine transaminase,ALT)值及碱性磷酸酶(Alkaline phosphatase,AKP)明显低于术前,差异有统计学意义(P<0.05);术前无感染症状患者黄疸消退情况明显好于感染患者,术后无感染症状患者黄疸消退情况均优于感染患者,差异有统计学意义(P<0.05)。结论PTBD及PTIBS治疗低位恶性梗阻性黄疸效果较好,可有效消退黄疸,提高生活质量,延长患者生存期,值得临床推广。

Objective To analyze the effect of percutaneous transhepatic bile drainage(PTBD)and biliary stent implantation(ptibs)in the treatment of low malignant obstructive yellow segment.Methods 65 patients with low malignant obstructive jaundice in hospital from June 2019 to June 2021 were selected.All patients were diagnosed by imaging examination.The causes of obstruction included 16 cases of cholangiocarcinoma,12 cases of ampulla cancer,12 cases of gallbladder cancer,15 cases of duodenal papilla cancer and 10 cases of pancreatic head cancer.The patients were treated with PTBD or ptibs according to the results of angiography.Results all 65 patients completed the operation,including 24 cases treated with PTBD,33 cases treated with ptibs and 8 cases treated with PTBD combined with ptibs.The level of TBIL decreased from(294.38±151.85)umol/L before operation to(150.84±105.38)umol/L after operation(P<0.05);The ALT value after operation was significantly lower than that before operation(P<0.05);The jaundice regression of asymptomatic patients before operation was significantly better than that of infected patients.The jaundice regression of asymptomatic patients after operation was better than that of infected patients,and the difference was statistically significant(P<0.05).Conclusion PTBD and ptibs are effective in the treatment of low malignant obstructive jaundice.They can effectively eliminate jaundice,improve the quality of life and prolong the survival time of patients.They are worthy of clinical promotion.