超声定位联合PTCD治疗低位恶性梗阻性黄疸的临床价值分析

Clinical value of ultrasound localization combined with PTCD in the treatment of low grade malignant obstructive jaundice

目的:探讨超声定位联合经皮肝穿刺胆道引流(PTCD)治疗低位恶性梗阻性黄疸的临床价值。方法:依据治疗方法不同将135例低位恶性梗阻性黄疸患者分为超声定位联合经皮经肝胆管置管引流术组(PTBD组)52例,超声定位联合经皮经肝胆囊置管引流术组(PTGD组)46例,经内镜鼻胆管引流术组(ENBD组)37例。对比各组置管次数、手术时间、手术成功率、有效带管时间、术后引流量、并发症以及手术前后肝功能指标、肝内胆管直径的差异。结果:与ENBD组比较,PTGD和PTBD组患者置管次数偏少(P<0.05),手术时间偏短(P<0.05),手术成功率偏高(P<0.05),术后有效带管时间偏长(P<0.05),术后胆管直径偏小(P<0.05),术后并发症发生率偏低(P<0.05),术后每日胆汁引流量、肝功能指标改善程度无差异(P>0.05)。与PTBD组对比,PTGD组置管次数偏少(P<0.05),手术时间偏短(P<0.05);与PTGD组比较,PTBD术后有效带管时间偏长(P<0.05)。结论:超声定位联合PTCD治疗低位恶性梗阻性黄疸具有操作简便、成功率高、并发症少的优势。PTBD可延长有效带管时间,更适合低位恶性梗阻性黄疸的姑息治疗。

Objective: To explore the clinical value of ultrasonography combined with percutaneous transhepatic cholangial drainage(PTCD)in the treatment of low grade malignant obstructive jaundice. Methods: According to different treatment methods,135 patients with low grade malignant obstructive jaundice were divided into the group of ultrasound localization combined with percutaneous transhepatic bile-duct drainage(PTBD group) 52 cases, the group of ultrasound localization combined with percutaneous transhepatic gallbladder drainage(PTGD group) 46 cases and the group of endoscopic nasobiliary drainage(ENBD group) 37 cases. The differences in the number of catheterization, operation time, operation success rate, effective catheterization time, postoperative drainage volume, complications, liver function index and intrahepatic bile duct diameter before and after surgery were compared in each group. Results: Compared with the ENBD group, patients in the PTGD group and PTBD group had fewer catheterization times(P<0.05),shorter operative time(P<0.05),higher success rate of operation(P<0.05),longer postoperative effective catheterization time(P<0.05),smaller postoperative bile duct diameter(P<0.05),and lower postoperative complication rate(P<0.05).There was no difference in postoperative daily bile drainage volume and liver function index among ENBD group, PTGD group and PTBD group(P>0.05).Compared with PTBD group, the PTGD group showed less catheterization times(P<0.05),shorter operative time(P<0.05),and the PTBD group showed longer effective catheterization time than PTGD group(P<0.05). Conclusion: Ultrasound localization combined with PTCD in the treatment of low grade malignant obstructive jaundice has advantages of simple operation, high success rate of operation and few complications. PTBD can prolong postoperative effective catheterization time and is more suitable for palliative treatment of low grade malignant obstructive jaundice.