经皮肝穿刺胆道引流术治疗老年肝内胆管结石梗阻性黄疸患者的疗效观察

Clinical Effect of Percutaneous Transhepatic Cholangial Drainage in the Treatment of Obstructive Jaundice in Elderly Patients with Intrahepatic Bile Duct Stones

目的探讨经皮肝穿刺胆道引流术(PTCD)治疗老年肝内胆管结石梗阻性黄疸患者的疗效和安全性。方法选取2014年1月至2015年7月医院肝胆外科收治的老年肝内胆管结石梗阻性黄疸患者40例为研究对象,按随机数字表法分为观察组和对照组,各20例。观察组患者行PTCD治疗,对照组患者采取禁食、补液、抗生素、抑酸、护肝等保守对症治疗,观察不同方法治疗后两组患者肝功能相关指标和血清胆红素水平的变化,同时记录临床症状缓解时间和患者的并发症发生情况,评价临床疗效。结果 PTCD治疗的观察组患者临床症状缓解时间明显短于对照组,且住院时间明显缩短,治疗成功率显著提高(均P<0.05);治疗后,两组患者的肝功能相关指标及血清胆红素均较治疗前下降,且观察组各指标明显低于对照组(均P<0.05),术后有5例出现并发症。结论 PTCD在老年肝内胆管结石梗阻性黄疸治疗方面疗效显著,具备有效性与安全性,在临床治疗中可以根据实际病情优先考虑实施。

Objective To observe and analyze the efficacy and safety of PTCD in the treatment of obstructive jaundice in elderly patients with intrahepatic bile duct stones.Methods 40 cases from January 2014 to July 2015 were selected were randomly divided into observation group and control group.The observation group were treated with PTCD,the control group took fasting,rehydration,antibiotics,acid suppression,hepatic protection and other conservative treatment measures.The changes of liver function related indexes and serum bilirubin level in the two groups after treatment were observed,and the time of clinical symptom relief and the occurrence of complications were recorded.Results The remission time of clinical symptoms in PTCD treatment group was significantly shorter than that in control group with shorter length of stay and higher success rate of treatment（P〈0.05）.After treatment, liver function parameters and serum bilirubin were decreased than before,and the observation group index was significantly lower than the control group（P〈0.05）.Postoperative complications occurred in 5 cases.ConclusionThe clinical effect of PTCD in the treatment of obstructive jaundice was significant with efficacy and safety,which may be considered in clinical application according to actual condition.