术前胆道减黄对肝门部胆管癌手术患者疗效及预后的影响

Influence of preoperative yellow reduction of bile duct on curative effect and prognosis of patients with hilar cholangiocarcinoma

目的探讨术前胆道减黄对肝门部胆管癌手术患者疗效及预后的影响。方法选取2015年3月～2017年3月我院收治的78例肝门部胆管癌患者作为研究对象,按就诊顺序随机分为实验组和参照组,每组各39例。参照组患者直接行肝切除手术治疗,实验组患者则先给予经皮经肝胆管引流减黄治疗再行肝切除术。观察实验组患者在减黄治疗前后的肝功能变化情况,并分析比较两组患者的手术相关指标、术后并发症发生情况以及术后1年内的死亡率。结果实验组减黄治疗后的总胆红素(TB)、丙氨酸氨基转移酶(ALT)、γ-谷氨酸氨基转移酶(γ-GT)以及碱性磷酸酶(ALP)等肝功能指标均低于治疗前,差异有统计学意义(P<0.05)。两组患者的手术时间、住院时间和术中输血量比较,差异无统计学意义(P>0.05)。实验组患者的术中出血量少于参照组,差异有统计学意义(P<0.05)。两组的术后并发症发生情况以及术后1年内死亡率比较,差异无统计学意义(P>0.05)。结论术前胆道减黄能有效改善肝门部胆管癌手术患者的肝功能,但并不能明显降低术后并发症的发生以及死亡率,对于术前肝功能较差的患者可综合考虑情况进行选择性减黄治疗。

Objective To investigate the influence of preoperative yellow reduction of bile duct on the curative effect and prognosis of hilar cholangiocarcinoma.Methods From March 2015 to March 2017,78 patients with hilar cholangiocarcinoma were selected and randomly divided into the experimental group and the reference group according to the order of treatment,with 39 patients in each group.The patients in the control group were treated with direct hepatectomy,the patients in the experimental group were treated with percutaneous transhepatic bile duct drainage before hepatectomy.The changes of liver function before and after treatment were observed in the experimental group,and the related indexes,postoperative complications and 1 year mortality were analyzed and compared between the two groups.Results The liver function indexes such as TB,ALT,γ-GT and ALP in the experimental group after treatment were all lower than those before treatment,the difference was statistically significant(P<0.05).There was no significant difference in operative time,hospitalization time and blood transfusion volume between the two groups(P>0.05),the amount of intraoperative blood loss in the experimental group was less than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in postoperative complications and 1-year mortality between the two groups(P>0.05).Conclusion Preoperative yellow reduction of bile duct can effectively improve liver function of patients with hilar cholangiocarcinoma,but it can not significantly reduce postoperative complications and mortality.Patients with poor preoperative liver function can be treated with selective yellow reduction.