阻塞性黄疸术前行PTCD对提高临床疗效的观察

The perioperative effects and clinical curative effect of preoperative percutaneous transhepatic cholangial drainage to the obstructive jaundice

目的探讨阻塞性黄疸术前经皮肝穿刺胆管引流(PTCD)对围手术期的影响及临床疗效。方法2010年2月至2012年6月间手术治疗的85例阻塞性黄疸患者,分为术前PTCD术组(n=46)和直接手术组(n=39);术前PTCD组观测入院时和行PTCD置管后第3、7天肝功能指标变化情况,同时比较两组术中出血量、手术时间,术后并发症及平均住院时间,术后肝功能指标变化。结果 PTCD组行PTCD置管后肝功能改善,与入院时比较有明显差异(P<0.05)。两组术后ALT、AST、TB指标相同时间点比较,差异均有统计学意义(P<0.05)。同时,PTCD组术中出血量、手术时间、术后并发症及平均住院时间均少于直接手术组(P<0.05)。结论 PTCD可作为阻塞性黄疸术前的常规应用,可促进肝功能的恢复,提高手术的耐受性,改善疗效。

Objective To explore the perioperative effects and clinical curative effect of preoperativepercutaneous transhepatic cholangial drainage （PTCD） to the obstructive jaundice. Methods From February 2010 to June 2012, 85 obstructive jaundice patients, were divided into preoperative PTCD group （n=46） and direct surgical group （n=39）; in the preoperative PTCD group, liver function changes on admission and after 3 and 7 d for PTCD were observed. Meanwhile, the amount of bleeding, operation duration, postoperative complications during the operation, mean time of hospitalization, and postoperative liver function change were compared between two groups. Results After PTCD group underwent PTCD, liver function were improved more than on admission （P〈0.05）. The postoperative ALT, AST, TB were remarkably different between the two groups （P〈0.05）. Compared with direct surgical group, the amount of intraoperative bleeding, operation duration, postoperative complications and mean time of hospitalization in PTCD group were remarkably less （P〈0.05）. Conclusion PTCD technique can be applied conventionally in obstructive jaundice preoperative, which can promote the recovery of liver function, improve the operative tolerance and improve curative effect.