晚期恶性梗阻性黄疸姑息引流治疗的临床疗效及预后分析

PALLIATIVE BILIARY DRAINAGE TREATMENT AND PROGNOSIS ANALYSIS OF ADVANCED MALIGNANT OBSTRUCTIVE JAUNDICE

目的比较不同的姑息引流治疗方法对晚期恶性梗阻性黄疸的临床疗效。方法回顾性分析我院2005～2011年收治的218例晚期恶性梗阻性黄疸患者的临床资料。结果 218例中开腹引流组55例,内镜引流组136例,PTCD引流组27例。三组治疗一周后总胆红素,直接胆红素、转氨酶水平较术前均有明显下降(P均<0.05),2周后减黄效果趋于稳定,但各组同期胆红素值的比较差异均无统计学意义(P均>0.05)。术后统计各组并发症发生情况,发现内镜引流组的并发症发生率明显低于其他两组,差异有统计学意义(P<0.05)。术后随访:内镜引流组的病人生存期与开腹引流组差异无统计学意义(P>0.05);但内镜引流组的病人生存期长于PTCD引流组(P<0.05)。结论不同引流方法在短期内减轻黄疸,改善肝功能方面无明显差异。开腹引流组和内镜引流组在延长生存期方面优于PTCD引流组,且考虑内镜介入治疗的安全性,故内镜介入治疗是晚期恶性梗阻性黄疸患者姑息治疗的首选。

Objective To compare effects of several kinds of Palliative biliary drainage treatments on prognosis of Advanced malignant obstructive jaundice. Methods Clinicopathological data of 218 patients with Advanced malignant obstructive jaundice trea- ted at the AnHui province Hospital from 2005 to 2011 were retrospectively analyzed. Results The 218 were divided into Open surgical drainage group （n = 55 ）and Endoscopic drainage group （n = 136）, PTCD drainage group （n = 27 ） according to different kinds of treat- ments. One week after drainage the levels of TBIL, DBIL and ALT of the patients undergoing treatment all decreased in comparison with those before the treatment（ P 〈 0. 05 ）. jaundice reduction effect become to stabilize until two weeks, and in each group over the same period of bilirubin showed no significant difference （ P 〉 0. 05 ）. The postoperative Statistics complications show the incidence of compli- cations of endoscopic drainage group was significantly lower than the other two groups , the difference was statistically significant （ P 〈 0. 05 ）. The survival of patients for Endoscopic drainage not significantly different from that of the surgical resection group（P 〈 0. 05）. but the survival of patients of the Endoscopic drainage group longer than the PTCD group （ P 〈 0. 05 ）. Conclusion There were no significant differences in reducing jaundice, improve liver function for different drainage methods. Open drainage group and endoscopic drainage group prolong survival better than the the PTCD drainage group, and consider the safety of endoscopic treatment Therefore, endoscopic treatment is palliative treatment of choice for patients with Advanced malignant obstructive jaundice.