复合胆道引流术治疗Bismuth Ⅳ型Klatskin肿瘤所致恶性梗阻性黄疸

Combined biliary drainage for treatment of malignant obstructive jaundice caused by Bismuth Ⅳ Klatskin tumors

目的观察2种复合胆道引流术治疗BismuthⅣ型Klatskin肿瘤所致恶性梗阻性黄疸(MOJ)的疗效。方法回顾性分析46例BismuthⅣ型Klatskin肿瘤所致MOJ、且接受胆道内外引流治疗的患者资料,根据引流方法分为经皮肝胆管引流术(PTBD)双侧引流组(19例)及经内镜鼻胆管引流术(ENBD)联合PTBD单侧引流组(27例),对比分析2组间胆道引流效果、术后患者生存时间及并发症发生率的差异结果 2组胆道引流技术成功率均为100%,引流有效率差异无统计学意义[89.47%(17/19)vs 92.59%(25/27);χ~2=0.02,P=0.831]。PTBD双侧引流组术后患者平均生存时间明显长于ENBD联合PTBD单侧引流组[(318.37±167.39)天vs(267.57±145.21)天;t=7.31,P=0.007],且并发症发生率明显低于ENBD联合PTBD单侧引流组[10.53%(2/19)vs 14.81%(4/27);χ~2=1.92,P=0.028]。结论 2种复合介入技术均可有效缓解BismuthⅣ型Klatskin肿瘤所致MOJ。PTBD双侧引流较ENBD联合单侧PTBD更有利于延长患者生存期。

Objective To explore the effect of two kinds of combined biliary drainage in the treatment of malignant obstructive jaundice（MOJ）caused by Bismuth Ⅳ Klatskin tumor.Methods Data of 46 MOJ patients caused by BismuthⅣ Klatskin tumor who received combined biliary drainage were retrospectively analyzed.The patients were divided into bilateral percutaneous transhepatic biliary drainage（PTBD）group（n=19）and endoscopic nasobiliary drainage（ENBD）combined with unilateral PTBD group（n=27）.Internal and external drainage of the biliary tract were performed.The clinical effect of drainage,survival time and complication rate after drainage were compared between the two groups.Results The technical success rates of drainage in both groups were 100%.There was no statistically significant difference in the effective rate of drainage between the two groups（89.47% [17/19]vs 92.59% [25/27];χ2=0.02,P=0.831）.Compared with ENBD combined with unilateral PTBD group,patients in bilateral PTBD group showed longer survival time（[318.37±167.39]days vs[267.57±145.21]days;t=7.31,P=0.007）and lower complication rate（10.52 %[2/19]vs 14.81% [4/27];χ2=1.92,P=0.028）after drainage.Conclusion Combined biliary drainage techniques can effectively alleviate MOJ caused by Bismuth Ⅳ Klatskin tumors and improve liver function.Bilateral PTBD is more beneficial to prolong patients＇ survival time than ENBD combined PTBD.