术前PTBD治疗对联合半肝切除的肝门部胆管癌根治术的安全性及有效性

Safety and effectiveness of preoperative PTBD therapy for radical resection of hilar cholangiocarcinoma combined with hemihepatectomy

目的探讨对于拟行联合半肝切除的肝门部胆管癌根治术的患者,术前行超声引导下经皮经肝胆管穿刺置管引流术(PTBD)治疗的有效性及安全性。方法回顾性分析2013年1-12月我院112例行联合半肝切除的肝门部胆管癌根治术的患者资料,总结分析其术前状态、手术情况及术后并发症发生情况。结果术中留取胆汁培养细菌阳性率差异无统计学意义(χ2=0.054,P=0.816)。PTBD组术前总胆红素为(107.1±29.6)μmol/L,NPTBD组术前总胆红素(135.6±85.2)μmol/L,差异有统计学意义(t=2.13,P=0.035)。PTBD组术后胆漏发生率较NPTBD组低,差异有统计学意义(χ2=4.952,P=0.026)。PTBD组切口感染、肝功不全等并发症发生率虽较NPTBD组低,但差异无统计学意义(P>0.05)。结论 PTBD作为一种安全、有效的减黄手段,可明显改善患者术前肝功能及全身营养状态,大大降低术后胆漏发生率。

Objective To investigate the safety and effectiveness of preoperative PTBD therapy for radical resection of hilar cholangiocarcinoma combined with hepatectomy. Methods Clinical data about 112 patients who underwent radical resection of hilar cholangiocarcinoma combined with hemihepatectomy admitted to our hospital from January to December in 2013 were retrospectively .analyzed. Then their preoperative condition, operation status and postoperative complications were summarized and analyzed. Results No statistically significant was found in positive rate of bacteria through culturing the bile which collected intraoperative between the two groups （χ^2=0.054, P=0.816）. The preoperative total bilirubin （TB） of group PTBD and group NPTBD was （107.1 ± 29,6）μmol/L and （135.6 ±85.2） μ mol/L, respectively. There was statistical significance in two groups （t=2.13, P=0.035）. The incidence of bile leakage after operation in group PTBD was lower than that of group NPTBD （χ^2=4.952, P= 0.026）. Although the rate of postoperation complication such as incision infection, hepatic insufficiency in group PTBD was lower than that of group NPTBD, the difference made no statistical significance. Conclusion PTBD is a safe and effective method to alleviate the symptoms of jaundice. It can significantly improve the patients＇ preoperative liver function and nutritional state and reduce the incidence of postoperative bile leakage.