不同介入方式对肝门部胆管癌的疗效研究

Effect and Prognosis of Different Interventional Methods of Hilar Cholangiocarcinoma

目的探讨与对比不同介入方式治疗肝门部胆管癌的预后。方法选择肝门部胆管癌患者110例,根据随机数字表法分为观察组与对照组各55例,对照组给予经内镜鼻胆管引流介入治疗,观察组给予经皮胆管穿刺引流介入治疗,记录与随访2组预后。结果2组的手术时间、术中出血量对比无统计学意义(P>0.05),观察组的红细胞输注量、术后住院时间显著少于对照组(P<0.05)。2组术后14 d的血清ALT与AST水平显著低于术后1 d(P<0.05),观察组也显著低于对照组(P<0.05)。观察组术后14 d的胰腺炎、胆脂瘤、肝出血、切口感染等并发症发生率为3.6%,显著低于对照组的20.0%(P<0.05)。随访至今(2019年7月),观察组的中位生存时间为(21.87±4.23)个月,显著高于对照组的(14.98±5.11)个月(t=14.592,P=0.000)。结论相对于经内镜鼻胆管引流,经皮胆管穿刺引流介入治疗肝门部胆管癌能促进患者术后肝功能恢复正常,加快患者康复,减少术后并发症的发生,延长患者的生存时间。

Objective To investigate and compare the prognosis of different interventional approaches for the treatment of hilar cholangiocarcinoma.Methods 110 patients with hilar cholangiocarcinoma who were treated and divided into the observation group and the control group,each with 55 patients according to the random number table method.The control group was treated with endoscopic nasobiliary drainage,and the observation group was treated with percutaneous biliary drainage.The prognosis of the 2 groups were recorded and followed up.Results There were no significant difference in the operation time and intraoperative blood loss compared between the 2 groups(P>0.05).The red blood cell transfusion volume and postoperative hospital stay in the observation group were significantly lower than those of the control group(P<0.05).The postoperative 14 d of serum ALT and AST levels were significantly lower than the postoperative 1 d(P<0.05),and the observation group were significantly lower than that of the control group(P<0.05).The incidences of complications such as pancreatitis,cholesteatoma,hepatic hemorrhage and wound infection were 3.6%in the observation group at 14 days after operation,which were significantly lower than that of the control group(20.0%)(P<0.05).The median survival time of the observation group was(21.87±4.23)months,which was significantly higher than that of the control group(14.98±5.11)months(t=14.592,P=0.000).Conclusion Compares with endoscopic nasobiliary drainage,percutaneous transhepatic biliary drainage for the treatment of hilar cholangiocarcinoma can promote the recovery of postoperative liver function,accelerate the recovery of patients,reduce the incidence of postoperative complications,and prolong the survival time of patients.