经皮经肝胆道穿刺引流联合丁二磺酸腺苷蛋氨酸在胰头癌围术期的应用

Perioperative application of percutanoeus transhepatic biliary drainage combined with ademetionine for the patients with pancreatic carcinoma

目的观察经皮经肝胆道穿刺引流(PTBD)联合丁二磺酸腺苷蛋氨酸(AME)在胰头癌患者围术期内的治疗效果。方法对35例胰头癌患者以PTBD进行术前减黄,并将患者分为单纯PTBD组(21例)及PTBD+AME治疗组(14例);PTBD组仅对患者进行胆道引流,PTBD+AME组在行PTBD胆道引流的同时静脉滴注AME1000mg/d。对两组患者的肿瘤切除率、术中出血量、并发症发生率以及肝功能变化等临床资料进行分析比较。结果PTBD组行胰十二指肠切除7例(33.3%),单纯内引流14例(66.7%);术中出血量为584±96ml,术后发生并发症5例次(23.8%)。PTBD+AME组行胰十二指肠切除5例(35.7%),单纯内引流9例(64.3%),术中出血量为493±84ml,术后发生并发症2例次(14.3%)。PTBD+AME治疗组手术前总胆红素(TB)、丙氨酸转氨酶(ALT)以及手术后1周的TB、ALT、天冬氨酸转氨酶(AST)均显著低于PTBD组(P<0.05)。结论与单纯以PTBD进行术前减黄比较,胰头癌患者在围术期以PTBD进行术前减黄的同时用AME治疗能够进一步促进黄疸消退及肝功能恢复,减少术中出血量,提高手术安全性。

Objective To observe the effect of percutanoeus transhepatic biliary drainage（PTBD） combined with ademetionine（AME） in the patients with pancreatic carcinoma during postoperative period.Methods Thirty-five patients treated with PTBD before operation were divided into two groups：simple PTBD group（n=21） and PTBD＋AME group（n=14）.In simple PTBD group,PTBD guided by B ultrasound was performed before operation.In PTBD＋AME group,besides PTBD,1000 mg of AME was given every day by intravenous infusion.The clinical data of the both groups were collected and analyzed.Results For the patients in simple PTBD group,pancreaticoduodenectomy was performed in 7 cases and simple biliary drainage was performed in 14 cases,the intraoperative blood loss was 584±96 ml,and the incidence of complication was 23.8%（5/21）.For the patients in PTBD＋AME group,pancreaticoduodenectomy was performed in 5 cases,and simple biliary drainage was performed in 9 cases,the intraoperative blood loss was 493±84 ml,and the incidence of complication was 14.3%（2/14）.The serum levels of total bilirubin（TB） and glutamic-pyruvic transaminase（GPT） before operation were significantly lower in PTBD＋AME group than in simple PTBD group.The levels of TB,GPT and aspartate aminotransferase（AST） were significantly lower in PTBD＋AME group than in simple PTBD group 1 week after operation.Conclusion Ademetionine can accelerate the restoration of liver function and reduce the intraoperative blood loss in the patients with pancreatic carcinoma treated with PTBD during postoperative period.