腹腔镜根治术治疗Bismuth Ⅰ型肝门部胆管癌的引流术式选择及Apgar评分比较

Options of preoperative biliary drainage and Apgar scores of patients with Bismuth Ⅰ hilar cholangiocarcinoma who received laparoscopic radical surgery

目的探究腹腔镜根治术治疗BismuthⅠ型肝门部胆管癌(HCCA)的引流术式选择及Apgar评分。方法回顾性分析2008年7月至2015年7月收治的58例行腹腔镜根治术治疗的BismuthⅠ型HCCA患者资料,根据术前引流方式不同分为两组,30例患者采用经皮肝穿刺胆道引流(PTBD)为PTBD组,28例患者采用经逆行胰胆管造影(ERCP)内支架引流为ERCP组。采用SPSS21.0软件进行分析,其中引流效果、Apgar评分等均以(x^-±s)描述,采用独立t检验;操作成功率和并发症发生率采用χ^2检验;P<0.05差异有统计学意义。结果PTBD组患者的平均术前引流时间、平均更换引流物次数等引流效果均少于ERCP组(P<0.05),而两组患者的引流后血清胆红素水平差异无统计学意义(P>0.05);PTBD组患者治疗后的Apgar评分高于ERCP组患者(P<0.05),胆道感染发生率低于ERCP组患者(P<0.05)。结论术前采用PTBD作为腹腔镜根治术的引流术式,引流效果更好,可显著改善患者的Apgar评分,降低术后胆道感染发生率,值得临床推广应用。

Objective To investigate the preoperative biliary drainage and Apgar scores of patients with BismuthⅠhilar cholangiocarcinoma who received laparoscopic radical surgery.Methods Retrospective analysis were performed in 58 patients with Bismuth type I hilar cholangiocarcinoma who underwent laparoscopic radical surgery from July 2008 to July 2015.According to the different preoperative drainages,30 patients in the PTBD group underwent percutaneous transhepatic biliary drainage(PTBD),while 28 patients in the ERCP group underwent endoscopic retrograde cholangiopancreatography(ERCP).The statistical analysis was performed by using SPSS21.0 software.Measurement data such as drainage effect and Apgar scores were expressed as mean±standard deviation and were examined by independent t test.The operation success rate and complication rate were described by(n,%)and were examined by chi square test.A P value of<0.05 was considered as statistically significant.Results The drainage indexs of PTBD group were better than those of ERCP group respectively(P<0.05),however there was no significant difference in serum bilirubin level between two groups(P>0.05);the Apgar score of PTBD group was higher than that of ERCP group(P<0.05),and the incidence of biliary tract infection was lower than that of ERCP group(P<0.05).Conclusion Preoperative PTBD in laparoscopic radical surgery for hilar cholangiocarcinoma has better drainage effect,which could significantly improve the patient’s Apgar score and reduce the incidence of postoperative biliary tract infection.It is worthy of clinical application.