经皮肝穿刺胆管引流术对肝门部胆管癌的临床疗效及预后分析

Clinical effect and prognosis of hilar cholangiocarcinoma treated by using percutaneous transhepatic biliary drainage

目的探究经皮肝穿刺胆管引流术(PTBD)对Bismuth-Corlette Ⅰ/Ⅱ型肝门部胆管癌(HCCA)临床治疗效果及预后的影响。方法回顾性分析2011年8月至2013年3月78例Ⅰ/Ⅱ型HCCA患者资料,其中42例患者采用PTBD治疗,设为PTBD组;36例患者采用经内镜鼻胆管引流术(ENBD)治疗,设为ENBD组。采用SPSS22.0软件进行分析,治疗前后肝功能指标等计量资料以(■±s)描述,独立t检验;引流成功率和并发症发生率采用χ^2检验分析;5年生存率采用Kaplan-Meier法进行生存分析,进行Log-Rank检验。P<0.05差异有统计学意义。结果PTBD组引流操作成功率85.7%(36/42)显著高于ENBD组63.9%(23/36),P<0.05;治疗后两组患者的TBA、TB、ALP和ALT水平均较治疗前有明显降低(P<0.05);PTBD组术后并发症率9.5%显著低于ENBD组27.8%(P=0.036);PTBD组5年生存率21.4%、平均生存时间(3.5±1.7)年;显著高于ENBD组5.6%(2.4±1.5)年,差异均有统计学意义(P<0.05)。结论采用PTBD治疗Ⅰ/Ⅱ期型肝门胆管癌的临床疗效良好,可改善患者的肝功能,降低并发症发生率,提高患者5年生存率,值得临床推广应用。

Objective To investigate the clinical effect and to analyze the prognosis of Bismith corlette Ⅰ/Ⅱ hilar cholangiocarcinoma treated by using percutaneous transhepatic biliary drainage(PTBD).Methods From August 2011 to March 2013,78 patients with Bismith corlette Ⅰ/Ⅱ hilar cholangiocarcinoma were enrolled into present study,among whom 42 patients received PTBD(PTBD group)and 36 patients received endoscopic nasobiliary drainage(ENBD group).Statistical analysis were performed by using SPSS22.0 software.Measurement data such as perioperative liver function index were described by (■±s) and were analyzed by using independent t test.Counting data such as success rate of drainage,incidence of complications were analyzed by usingχ^2 test.5-year-survival analysis was performed by using Kaplan-Meier method.A P value<0.05 was considered as statistically significant difference.Results Compared with patients in the ENBD group,the success rate of drainage in the PTBD group was significantly higher(85.7%vs.63.9%,P<0.05);The levels of TBA,TB,ALP and ALT in both 2 groups were significantly decreased after drainage treatment(P<0.05).The incidence of complications of 9.5%in the PTBD group was significantly lower than 27.8%in the ENBD group(P=0.036).The 5-year survival of 21.4%in the PTBD group(with average of 3.5±1.7 years)was significantly higher than 5.6%in the ENBD group(with average of 2.4±1.5 years)(P=0.004).Conclusion The clinical efficacy of PTBD in the treatment of Bismith corlette Ⅰ/Ⅱ hilar cholangiocarcinoma is satisfactory,which could improve the liver function,reduce the risk of complications,and improve the 5-year survival of patients.It is worthy of wider clinical application.