低位胆管恶性梗阻的经皮肝穿刺胆管引流方式探讨

Assessment of percutaneous transhepatic biliary drainage for malignant low biliary obstruction

目的探讨经皮肝穿刺胆管引流方式在减少低位胆管恶性梗阻患者术后胆管感染中的作用。方法 56例接受经皮肝穿刺胆管引流术的低位胆管恶性梗阻患者纳入本研究,所有患者均无肠梗阻及肠道手术史,将其随机分为试验组(n=31)和对照组(n=25)。先行外引流术(BED),再行内外引流术(BIED),试验组术后即关闭外引流,仅作单纯内引流;对照组内外引流同时开放。检测BED术前、BED术后、BIED术后30天内的血白细胞计数,并进行统计学分析。结果两组患者均成功完成引流。试验组、对照组BED术后的血白细胞计数分别为(6.75±1.06)×109/L和(6.98±1.04)×109/L,无统计学差异(t=0.83,P>0.05);而BIED术后试验组血白细胞计数[(7.23±2.19)×109/L]低于对照组[(10.74±5.21)×109/L,t=3.16,P<0.05]。结论对于低位胆管恶性梗阻,在单纯外引流的基础上择期置入内外引流管,术毕即关闭外口,仅作单纯内引流,可明显减少术后胆管感染的发生率。

Objective To explore the methodology of percutaneous transhepatic biliary drainage for patients with malig- nant low biliary obstruction, in order to decrease postoperative infection of biliary tract. Methods Fifty-six patients with malignant low biliary obstruction who underwent percutaneous transhepatic biliary drainage were included, including 31 in experimental group and 25 in control group. All patients had no history of intestinal obstruction and operation. Biliary in- ternal-external drainage （BIED） was performed after biliary external drainage （BED）. Patients in experimental group closed the external orifice of BIED tube immediately after operation and received single internal drainage. On the contrary, pa- tients in control group received conventional BIED. White blood cell （WBC） was recorded pre- and post-procedures for both groups, and the data were analyzed statistically. Results All the procedures were successfully performed in all patients. After BED, the mean WBC amount was （6.75 ± 1.06） X 109/L in experimental group and （6.98 ±1.04） X 109/L in control group （t = 0. 83, P〉 0.05）. After BIED, the mean WBC amount of experimental group （[-7.23± 2.19] X 109/L） was low- er than in control group （[10.74±5.21] X 109/L）, and the difference was statistical （t= 3.16, P〈0.05）. Conclusion The improved method of single internal drainage by shutting clown the external orifice of BIED tube immediately after oper- ation may markedly reduce postoperative infection of biliary tract in patients with malignant low biliary obstruction.