两种不同经皮肝穿刺胆道引流术的疗效观察

Percutaneous transhepatic cholangiography and drainage for malignant obstructive jaundice

目的探讨经皮肝穿刺胆道引流术（percutaneous transhepatic cholangiography and drainage, PTCD）两种不同引流方式对梗阻性黄疸的疗效。方法回顾性分析因梗阻性黄疸收治并行PTCD引流术的111例患者。根据术中导管末端是否越过壶腹部，进入十二指肠为标准分为外引流组54例和内外引流组57例。分析两种术式减黄效果、术后并发症、重新置管次数、住院时间和住院总费用等。结果两组术后TBiL均较术前有明显降低，差异有统计学意义（t=2．338，P〈0．05）。比较2组术后DBiL值，差异有统计学意义（t=2．201，P〈0．05）。外引流组术后出现胆道感染者14例；内外引流组术后胆道感染者27例，差异有统计学意义（χ^2=5．473，P〈0．05），2组总住院费用差异有统计学意义（t=-2．200，P〈0．05）。结论内外引流较内外引流有更好的引流效果，但易致胆道感染．增加患者住院费用。

Objective To study the effect of two different percutaneous transhepatic cholangiography and drainage （ PTCD ） procedures for malignant obstructive jaundice. Methods According to whether the tip of the catheter was carried across the ampulla and into the duodenum, patients were divided into external drainage group （54 cases） and both internal and external drainage group （57 cases）. The effects of two surgical procedures on reducing jaundice, the postoperative complications, hospitalization days, and total hospitalization expenses were evaluated. Results Postoperative TBiL decreased significantly in both the two groups （ t = 2. 338, P 〈 0. 05 ）. The postoperative DBiL values went even lower in both external and internal group （t = 2. 201, P 〈 0.05 ）. There were 14 cases of biliary tract infection in the external drainage group, and 27 cases in two ways group （χ^2= 5. 473, P 〈 0. 05 ）. Total hospitalization expenses were statistically different between the two group （t = - 2. 200, P 〈 0.05 ）. Conclusion The internal and external drainage has a better drainage effect than the external drainage group , but more likely to cause infection of biliary tract, increase hospitalization expenses.