超声引导下PTCD联合外科保守治疗恶性梗阻性黄疸分析体会

Ultrasound Guided PTCD Combined with Surgical Conservative Treatment of Malignant Obstructive Jaundice

目的分析超声引导下PTCD联合外科常规保守治疗和仅用外科常规保守治疗恶性梗阻性黄疸患者的临床治疗效果。方法随机选取该院2014年8月—2016年8月收治的58例恶性梗阻性黄疸患者的资料,将其分为对照组与观察组。其中对照组采用外科常规保守治疗,观察组采用PTCD联合外科常规保守治疗。观察两组患者治疗前后的临床症状、血清总胆红素(TB)、直接胆红素(DB)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、白蛋白(Alb)的变化情况。结果观察组患者的血清总胆红素(98.2±27.8)滋mol/L、直接胆红素(79.8±22.7)滋mol/L,血清碱性磷酸酶(286.3±194.5)U/L、丙氨酸氨基转移酶(63.5±36.1)U/L,血清白蛋白(32.3±4.1)g/L,对照组患者血清总胆红素(141.1±98.7)滋mol/L、直接胆红素(126.3±97.9)滋mol/L,血清碱性磷酸酶(361.2±234.7)U/L、丙氨酸氨基转移酶(89.1±61.8)U/L,血清白蛋白(25.5±1.2)g/L,两组患者TB、DB、ALP、ALT、ALB差异有统计学意义(P﹤0.05)。结论超声引导下PTCD联合外科常规保守治疗恶性梗阻性黄疸患者效果比仅用外科常规保守治疗效果更好,患者肝功能恢复更明显能够有效降低患者的黄疸症状,值得医院推广和临床治疗。

Objective To analyze the clinical effect of ultrasound-guided percutaneous transhepatic cholangial drainage in treatment of malignant obstructive jaundice. Methods 58 cases of patients with malignant obstructive jaundice under the ultrasound-guided percutaneous transhepatic cholangial drainage admitted and treated in our hospital from August 2013 to August 2015 were selected and divided into two groups, the control group with 29 cases were treated with percutaneous transhepatic gallbladder drainage, while the observation group with 29 cases were treated with percutaneous transhepatic cholangial drainage, and the clinical symptoms, TB, DB, ALP, ALT, Alb changes of patients before and after treatment were observed. Results After treatment, the serum total bilirubin decreased by 57.25%, direct bilirubin decreased by 47.26%,serum alkaline phosphatase decreased by 44.90%, alanine aminotransferase decreased by 49.20%, serum albumin gradually increased to 90.00% in the observation group, and in the control group, the serum total bilirubin decreased by 38.57%, direct bilirubin decreased by 16.52%, serum alkaline phosphatase decreased by 30.54%, alanine aminotransferase decreased by 28.72%, serum albumin gradually increased to 50.00%, and there was no obvious difference in the TB between the two groups without statistical significance(P>0.05), and the differences in the DB,ALP,ALT,ALB were obvious with statistical significance(P<0.05). Conclusion The effect of ultrasound-guided percutaneous transhepatic cholangial drainage in treatment of malignant obstructive jaundice is better than that of PIGD, and the liver function recovery rate of patients gradually increases, which can effectively reduce the jaundice symptoms, and it is worth promotion and treatment in clinic.