传统经皮肝穿刺胆道内外引流术与改良穿刺引流术治疗UMBO的对比分析

The Contrasting Analysis of Traditional PTBIED and Improving PTBD for Upper Malignant Biliary Obstruction

目的探讨传统皮肝穿刺胆道内外引流术与改良穿刺引流术对治疗高位恶性胆道梗阻(UMBO)的临床疗效。方法选取2003至2010年河南科技大学附属第一医院不能手术切除的恶性高位胆道梗阻患者75例,其中38例患者行引流管内外引流分为传统组,37例患者行改良内外引流分为改良组,比较两组患者临床疗效及生存时间。结果两组患者术后1周总胆红素、直接胆红素、丙氨酸转氨酶下降值无显著差异(P>0.05);改良组术后14d胆汁细菌培养较传统内外引流组阳性率明显下降(P<0.05);生存率改良组较内外引流组长(P<0.05)。结论改良式经皮肝穿刺胆道引流术,是一项方便可行、安全有效、成功率较高的介入手术方法,值得临床广泛推广。

Objective To discuss the treating efficacy of traditional PTBIED and improving PTBD in upper malignant biliary obstruction.Method From January 2003 to June 2010,in The First Affiliated Hospital,Henan University of Science and Technology,consecutive 75 incapable of operation patients with upper malignant biliary obstruction were performed interventional therapy.they were divided two groups：38 patients were performed percutaneous transhepatic biliary internal-external drainage（PTBIED）.37 patients were performed improving percutaneous transhepatic biliary drainage（IPTBD）.Results Serum total bilirubin、direct bilirubin were descended significantly after interventional therapy.The data were not statistical significance in each groups（P〉0.05）.ALT did not obviously descend.The positive rate of bile bacteriology cultivation in 14 day were significancily high in PTBIED type（P〈0.05）.Survival time in IPTBD groups were nice to PTBIED groups（P〈0.05）.No significantly difference were in PTBSP、IPTBD groups（P〉0.05）.The hospitalized time were similar to each groups.but the hospitalized expenses of PTBSP group was obviously higher than other three groups（P〈0.05）.Conclusions The technique of improving PTBD is a availabily Interventional therapy measerment to upper malignant biliary obstruction.