数字减影血管造影与超声引导下行PTCD治疗晚期恶性梗阻性黄疸的临床疗效

Efficacy of percuteneous transhepatic cholangio drainage under digital subtraction angiography guided by ultrasound ultrasound in the treatment of advanced malignant obstructive jaundice

目的探讨数字减影血管造影(DSA)与超声引导下行经皮肝穿刺胆道引流(PTCD)治疗晚期癌症所致恶性梗阻性黄疸(MBOJ)的疗效。方法选取2014年2月至2015年10月间上海市杨浦区中心医院收治的68例恶性梗阻性黄疸患者进行回顾性分析,根据不同穿刺方法分为甲组和乙组,每组34例。甲组患者采用DSA与超声引导下行PTCD,乙组患者采用传统超声引导下行PTCD。比较两组患者引流方式、引流管位置、肝功能[谷草转氨酶(AST)、谷丙转氨酶(ALT)和血清总胆红素(TBL)]及治疗结果(临床资料、生存率、并发症和一次成功率)。结果甲组患者内外引流和单管双侧均高于乙组,差异均有统计学意义(均P<0.05)。术后,两组患者肝功能指标AST、ALT和TBL均较术前下降,且甲组患者各项因子均低于乙组,差异均有统计学意义(均P<0.05)。甲组患者手术时间和出血量均低于乙组,1年生存率和一次成功率均高于乙组,差异均有统计学意义(均P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论 DSA联合超声引导下行PTCD相较单独超声引导,有更为优越的治疗效果,可提高患者的一次成功置管率和生存率。

Objective To explore the effect of efficacy of percuteneous transhepatic cholangio drain- age （PTCD） under digital subtraction angiography （DSA） guided by ultrasound in the treatment of advanced malignant obstructive jaundice （MBOJ）. Methods A retrospective study of 68 patients with MBOJ admitted to Yangpu District Central Hospital of Shanghai from February 2014 to October 2015 was conducted. Accord- ing to the puncture way, patients were divided into group A and group B with 34 patients in each group. Group A was given DSA and PTCD guided by ultrasound. Group B underwent traditional ultrasound-guided PTCD. The flow of drainage, the position of the drainage tube, the liver function including aspertate amin- otransferase （AST）, alanine transaminase （ALT）, and serum total bilirubin （TBL）, and the treatment re- suits including clinical data, survival rate, morbidity, and first pass yield rate. Results For group A, the internal and external drainage and the two-sided single tube which was higher than group B （ all P 〈 O. 05 ）. After the surgery, the liver function index AST, ALT and TBL significantly decreased compared with before the surgery with group A lower than group B （ all P 〈 0. 05 ）. The operation time and hemorrhage volume were significantly lower in group A than in group B and 1-year survival and first pass yield rate were higher in group A than in group B （ all P 〈 0. 05 ）. There was no significant difference in complications between the two groups （P 〉 0. 05 ）. Conclusion DSA combined with ultrasound guided PTCD was superior to single ultra- sound guidance with more excellent therapeutic efficacy. To improve the treatment efficacy, success rate of catheterization and survival rate should be improved.