内外PTCD与胆管支架介入治疗恶性梗阻性黄疸的临床研究

Clinical study of interventional treatment of malignant obstructive jaundice with PTCD and biliary stent

目的:回顾性研究内外经皮经肝胆管引流术(PTCD)及胆管支架介入(BDSIT)治疗恶性梗阻性黄疸(MOJ)的临床效果。方法:选择2013年1月至2016年12月在我院治疗的80例MOJ患者,依照治疗方法分为联合组(n=40)与对照组(n=40),联合组行内外PTCD合并BDSIT治疗,对照组行单纯外引流PTCD并BDSIT治疗。观察两组患者治疗前及治疗7天后血清门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、胆汁酸(TBA)、间接胆红素(ILBI)、直接胆红素(DBIL)、总胆红素(TBIL)等肝功能指标,术前及术后4周两组患者白细胞、白蛋白水平,术后并发症,术后生存情况及临床疗效。结果:术后7天,两组患者血清AST、ALT、TBA、ILBI、DBIL、TBIL均降低,联合组血清AST、ALT、TBA、ILBI、DBIL、TBIL均低于对照组,差异有统计学意义(P<0.05)。术后4周,两组患者白细胞均降低,白蛋白均升高,联合组白细胞低于对照组,白蛋白高于对照组,差异有统计学意义(P<0.05)。联合组显效率(85.00%)、术后1年生存率(67.50%)高于对照组显效率(45.00%)、术后1年生存率(45.00%),差异有统计学意义(P<0.05)。联合组术后并发症发病率(7.50%)低于对照组(25.00%),差异有统计学意义(P<0.05)。结论:内外PTCD并BDSIT治疗MOJ可快速引流梗阻胆汁,改善肝功能,提高临床疗效,减少术后并发症,值得应用于临床。

Objective:To aretrospective study the clinical effect of percutaneous transhepatic cholangial drainage(PTCD)and biliary stent implantation(BDSIT)in the treatment of malignant obstructive jaundice(MOJ).Methods:80 MOJ patients were selected from January 2013 to December 2016,according to the treatment methods,the patients were divided into the Combined Group(n=40)and the Control Group(n=40),the combination group was treated with internal and external PTCD combined with BDSIT,the control group was treated with external drainage PTCD combined with BDSIT.Liver function indexes of the two groups before and after treatment were observed,including serum AST,ALT,TBA,indirect bilirubin(ILBI),direct bilirubin(DBIL),total bilirubin(TBIL),etc.Leucocyte and albumin levels in the two groups before and 4 weeks after surgery,Postoperative complications,Postoperative survival and clinical efficacy.Results:Seven days after surgery,serum AST,ALT,TBA,ILBI,DBIL and TBIL were all reduced in both groups,Serum AST,ALT,TBA,ILBI,DBIL and TBIL in the combined group were all lower than those in the control group,the difference was statistically significant(P<0.05).4 weeks after surgery,white blood cells were decreased in both groups,albumin was elevated,leukocytes in the combined group were lower than those in the control group,albumin was higher than the control group,the difference was statistically significant(P<0.05).Combined group efficiency(85.00%),the 1-year survival rate(67.50%)was higher than that of the control group(45.00%),Postoperative 1-year survival rate(45.00%),the difference was statistically significant(P<0.05).The incidence of postoperative complications in the combined group(7.50%)was lower than that in the control group(25.00%),the difference was statistically significant(P<0.05).Conclusion:Internal and external PTCD combined with BDSIT in the treatment of MOJ can rapidly drain obstructive bile,improve liver function,improve clinical efficacy,reduce postoperative complications,worthy of clinical application.It is worthy of clinical application.