超声引导经皮经肝胆道穿刺引流术治疗肝泡型包虫病合并梗阻性黄疸的疗效分析

Ultrasound guided percutaneous transhepatic cholangial drainage for the treatment of hepatic alveolar echinococcosis with obstructive jaundice

目的探讨肝泡型包虫病合并梗阻性黄疸患者行超声引导经皮经肝胆道穿刺引流术(PTCD)的临床效果。方法选取武汉市第七医院2013年4月至2017年4月收治的80例肝泡型包虫病合并梗阻性黄疸患者,均行超声引导PTCD术治疗,记录患者术中和术后一般情况、不良反应发生情况,分析和比较肝功能指标变化、生活质量(QOL)评分。结果 80例患者一次性穿刺成功率为93.75%(75/80),平均手术时间为(36.31±8.57)min,术中出血量为(30.25±18.62)ml,住院时间为(5.25±2.12)d;术后平均每天胆汁引流量(507.34±86.54)ml,术后穿刺管平均留置时间(85.75±12.54)d,未出现胆管出血或败血症等并发症。与术前各指标比较,患者手术后3 d、1周、3个月后总胆红素(TBIL)、直接胆红素(DBIL)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)表达水平显著降低,且随治疗时间的延长,各指标表达水平逐渐下降(均P<0.05),治疗3 d、1周、1个月后患者QOL总均分分别为(20.87±0.85)分、(32.85±3.61)分、(45.63±5.78)分,显著高于治疗前的(14.54±0.62)分,差异均有统计学意义(P<0.05)。结论超声引导下PTCD治疗肝泡型包虫病合并梗阻性黄疸,能改善患者肝功能,提高生活质量,减少不良反应的发生。

Objective To investigate the clinical efficacy of ultrasound-guided percutaneous transhepatic cholangial drainage（PTCD） in the treatment of hepatic alveolar echinococcosis with obstructive jaundice. Methods Eighty cases of hepatic alveolar echinococcosis with obstructive jaundice were treated in the Seventh Hospital of Wuhan from April 2013 to April 2017. Ultrasound guided PTCD therapy was performed. The general situation and adverse reaction of the patients were recorded, and the changes of liver function index and quality of life（QOL） were analyzed and compared. Results The success rate of patients with disposable puncture was 93.75%（75/80）, the average operation time was（36.31±8.57） min, the amount of hemorrhage of（30.25±18.62） ml, hospitalization time was（5.25±2.12） d, the average daily postoperative biliary drainage（507.34±86.54） ml, retention time of puncture tube was（85.75±12.54） d. No complications such as bile duct bleeding or septicemia were found. Compared with the preoperative indexes, total bilirubin（TBIL）, direct bilirubin（DBIL）, glutamyl transpeptidase（GGT）, alkaline phosphatase（ALP）, aspartate transaminase（AST）, alanine aminotransferase（ALT）, albumin（ALB） expression levels at 3 days, 1 week and 3 months after surgery were significantly lower, and the expression level of each index decreased gradually with the prolongation of treatment time（all P〈0.05）. The total score of QOL was（20.87±0.85）,（32.85±3.61）, and（45.63±5.78） respectively, which were significantly higher than those before treatment（14.54±0.62）, the differences were statistically significant（P〈0.05）. Conclusion Ultrasound guided PTCD can improve the liver function and obstructive jaundice, enhance QOL and reduce the incidence of adverse reactions in the treatment of patients with hepatic alveolar echinococcosis.