胆管引流术联合熊去氧胆酸治疗恶性梗阻性黄疸

The Treatment of Malignant Biliary Obstruction by Biliary Drainage with Ursodeoxycholic Acid

目的分析胆管引流术联合熊去氧胆酸(UDCA)治疗恶性梗阻性黄疸的临床疗效。资料与方法76例恶性梗阻性黄疸患者,其中肝胆管癌32例,肝门淋巴结转移瘤23例,胰腺癌和壶腹癌21例。随机分为两组:观察组40例,对照组36例。全部患者给予保肝、支持、抗炎治疗,并行经皮经肝穿刺胆管内支架置入术或胆管引流术。观察组同时联合应用UDCA10～15mg.kg-1.d-1,疗程1个月。结果76例中46例行胆管内支架置入术,18例行胆管内外引流术,12例行胆管外引流术。观察组在术后7天、14天及30天血清胆红素均明显下降,术后14天与术后30天血清胆红素水平与对照组比较差异有统计学意义(P<0.05)。胆管梗阻解除后,随着血清胆红素的下降,谷丙转氨酶(ALT)、碱性磷酸酶(ALP)也随之下降,术后14天、30天两组间比较差异有统计学意义(P<0.05)。观察组22例合并胆系感染者,胆管炎控制时间(9±2.1)天,对照组19例胆管炎控制时间(12±1.6)天,两组间差异有统计学意义(P<0.001)。结论胆管引流术是姑息性治疗恶性梗阻性黄疸的有效手段。联合应用UDCA,可加强胆汁排泌,加快降黄速度,保护肝细胞,从而增强保肝降黄的作用。

Objective To evaluate the effect of percutaneous biliary drainage in palliative treatment of malignant biliary obstruction combined with Ursodeoxycholic acid （UDCA）. Materials and Methods Percutaneous metallic stents or biliary drainage was performed in 76 patients with malignant biliary obstruction. 32 patients had cholanglocarcinoma, 23 patients＇ biliary passage was obstructed by portal lymph node metastasis, and 21 patients had pancreas carcinoma or ampulla carcinoma. All the patients who were given protected liver therapy, support therapy, and anti - inflammation therapy were randomly divided into two groups： the observing group and control group. The observing group was given UDCA 10 mg/kg - 15 mg/kg a day in the meantime about one month. Results 46 patients were treated by percutaneous metallic stents, 18 patients were treated by interual-exterual biliary drainage, and 12 patients were treated only by external biliary drainage. In the observing group, the serum bilirubin was significant decreased after drainage 7 days, 14 days, and 30 days. The blood serum bilirubin had significant difference compared with the control group in 14 days and 30 days （ P 〈 0.05）. The ALP, AKP were decreased too in 14 days, 30 days after drainage, and had significant difference compared with the control group （P 〈0.05）. 22 patients who had bile duct infection in the observing group were controlled in （9 ± 2.1 ） days. 19 patients of the control group with bile duct infection were controlled in （ 12 ± 1.6） days, and had significant difference between the two groups（ P 〈 0.001 ）. Conclusion Percutaneous biliary drainage is an efficient method of treating malignant biliary obstruction, and it can reinforce the therapy result by decreasing blood serum bilirubin and protect the hepatocyte combined with UDCA.