PTCD联合鼻肠营养管行外引流胆汁回输及肠内营养对内脏蛋白及肝功能的影响

Effect of percutaneous transhepatic cholangial drainage with bile reinfusion and enteral nutrition via the nasojejunal tube on visceral protein and hepatic function

目的探讨恶性梗阻性黄疸患者PTCD联合鼻肠营养管行外引流胆汁回输及肠内营养的临床应用价值。方法40例恶性梗阻性黄疸患者随机分为:行PTCD同时留置复尔凯鼻肠营养管组(试验组)和单纯行PTCD组(对照组)。观察两组患者围手术期肝功能、内脏蛋白及术后并发症等情况。结果术后两组患者肝功能指标ALT、AST、TB-2等与术前比较均显著下降(P<0.05),术后试验组和对照组肝功能比较无显著性差异(P>0.05)。两组患者术后内脏蛋白指标ALB、TRF、PRE与术前比较均有显著上升(P<0.05),试验组和对照组比较对ALB、PRE影响无显著性差异(P>0.05),对TRF有显著性差异(P<0.05),试验组TRF明显高于对照组。结论PTCD外引流胆汁回输结合早期肠内营养支持有助于恶性梗阻性黄疸患者术后肝功能及内脏蛋白的恢复。

Objective To discuss the clinical value of percutaneous transhepatic cholangial drainage （PTCD） combined with nasojejunal tube for bile reinfusion and enteral nutrition for patients with malignant obstructive jaundice. Methods Forty patients with malignant obstructive jaundice were randomly divided into bile reinfusion group （n=20） and exclusive external drainage group （control group, n=20）, and the clinical data concerning the hepatic function, visceral protein and postoperative complications of the patients were collected. Results In both of the two groups, the levels of ALT, AST, and TB-2 reduced significantly after the operation as compared with the preperative levels （P0.05）, and no significant difference was found in the postoperative hepatic function between the two groups （P0.05）. The postoperative levels of the visceral proteins such as ALB, TRF and PRE increased significantly after the operation （P0.05）, and the changes in ALB and PRE were comparable between the two groups （P0.05）. TRF was significantly higher in bile reinfusion group than in the control group. Conclusion PTCD combined with bile reinfusion and early enteral nutrition via the nasojejunal tube may facilitate the recovery of hepatic function and visceral proteins in patients with malignant obstructive jaundice.