恶性梗阻性黄疸经皮肝穿刺胆汁引流前瞻性对照研究

Prospective control study of PTBD for the malignant obstructive jaundice

目的 通过前瞻性临床对照研究，比较经皮肝穿胆道引流术（ PTBD）不同引流方法治疗恶性梗阻性黄疸的近期疗效。方法 应用PTBD治疗符合入组标准的恶性梗阻性黄疸病例91例，男性57例，女性34例，年龄范围30～81岁，平均（60.4±11.6）岁。行PTIEBD（内外引流）的患者随机入组：IED-A组（餐后关闭引流2 h）20例、IED-B组（日间关闭引流）20例、IED-C组（持续关闭引流）15例；行PTEBD（外引流）患者36例。对术前3天内、术后2～4天、术后8～10天、术后1个月血清总胆红素（TBIL）、直接胆红素（DBIL）、谷草转氨酶（AST）、碱性磷酸酶（ALP）进行统计学方差分析。结果 术前3天内各组肝功能各指标差异无显著性（P〉0.05）。术后1个月TBIL、DBIL水平IED-B组〉IED-A组〉ED组，各组间两两比较均有显著性差异（P〈0.05）； AST水平ED组〉IED-A组〉IED-B组； IED-A组、B组与ED组比较有显著性差异（P〈0.05）； ALP水平IED-B组〉IED-A组〉ED组，ED组、IED-A组与IED-B组比较差异显著（P〈0.05）。与术前相比，IED-C组患者术后2～4天TBIL、DBIL、AST、ALP均无明显降低（ P均〉0.05）。结论 不同的引流方法各有其特点，可根据临床情况选择不同的引流方法。IED-C组引流方法不宜采用。

Objective To evaluate the effect of the different methods of percutaneous transhepatic biliarydrainage （PTBD） to treat the patients with the malignant obstructive jaundice throught this prospective clinicalcontrol study. Methods There are 91 consecutive cases with the malignant objective jaundice （M：F=57：34）, meanage （60.4±11.6 years） who were selected by our standard were accepted PTBD therapy. The patients who undergoPTIEBD will be send into three group at random： group IED-A （turn off drainage for 2 h after each meal） 20 cases,group IED-B （turn off drainage duaring daytime） 20 cases, group IED-C （turn off drainage persistently） 15 cases.Thirty-six patients underwent PTIEBD. TBIL, DBIL, AST, ALP before operation and 2—4 days, 8—10 days, and 1month after the operation were analyzed by ANOVA test. Results There is no obvious difference in TBIL, DBIL,AST, ALP among these groups before operation （P〉0.05）. At 1 month after PTBD, the level of TBIL, DBIL： groupIED-B〉group IED-A〉group ED, and the difference between three group is obvious（P〈0.05）; the level of AST： groupED〉group IED-A〉group IED-B, and comparing group ED with group IED-A or group IED-B, the difference isobvious（P〈0.05）; the level of ALP： group IED-B〉group IED-A〉group ED, and comparing group IED-B with groupIED-A or group ED, the difference is obvious （P〈0.05）. TBIL、DBIL、AST、ALP did not descend obviously afteroperation in IED-C group （P〉0.05）. Conclusions The different drainage has its own benefit, we should adopt thedrainage according to the patient’s situation. Turn-off drainage is not recommended.