超声引导下PTCD治疗肝门部胆管癌的临床疗效观察

Clinical Efficacy of Ultrasound-guided PTCD in the Treatment of Hilar Cholangiocarcinoma

【目的】总结近5年来首都医科大学宣武医院对肝门部胆管癌患者进行经皮经肝穿刺胆道引流术(PTCD)治疗的技术经验。【方法】回顾性分析2015年1月至2019年10月期间首都医科大学宣武医院因肝门部胆管癌行超声引导下PTCD治疗的86例患者的临床资料。记录患者手术相关情况及术后并发症发生情况,比较患者术前及术后2周肝功能相关指标,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)、总胆红素(TBIL)、直接胆红素(DBIL)。【结果】本研究86例患者经历108例次穿刺,穿刺肝左叶胆管76例,右叶胆管32例,其中左右双侧胆管同时穿刺22例。首次穿刺成功率为77.78%(84/108),总技术成功率为90.74%(98/108),临床成功率为86.05%(74/86)。术后发生胆管出血12例(13.95%),胆道感染及腹膜炎32例(37.21%),引流管脱落6例(6.98%)。术后22例患者黄疸减退后行肿瘤根治性切除或姑息性切除术,64例不能手术切除的患者带管出院。术后患者血清ALT、GGT、ALP、TEIL、DBIL水平均低于术前,差异均有统计学意义(P<0.05)。【结论】超声引导下PTCD是肝门部胆管癌患者重要治疗方法,通过单纯胆道外引流可改善其肝功能,并可达到减黄的目的,提高患者生存质量,在基层医院有推广意义。

【Objective】To summarize the experience of PTCD treatment for hilar cholangiocardnoma in Xuanwu Hospital of Capital Medical University in recent 5 years.【Methods】The clinical data of 86 patients with hilar cholangiocarcinoma treated with ultrasound-guided PTCD in Xuanwu Hospital of Capital Medical University from January 2015 to October 2019 were retrospectively analyzed.The operation related conditions and postoperative complications were recorded.The liver function indexes including alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),glutamyltransferase(GGT),total bilirubin(TBIL)and direct bilirubin(DBIL)were compared before and 2 weeks after operation.【Resuits】In this study,86 patients underwent 108 times of puncture;including 76 cases of left lobe bile duct and 32 cases of right lobe bile duct,there were 22 cases of left and right bile ducts punctured at the same time.The first puncture,success rate was 77.78%(84/108),the total technical success rate was 90.74%(98/108),and the clinical success rate was 86.05%(74/86).Postoperative bile duct bleeding occurred in 12 cases(13.95%),biliary tract infection and peritonitis in 32 cases(37.21%),and drainage tube shedding in 6 cases(6.98%).After operation,22 patients with jaundice were treated with radical or palliative resection.64 patients who could not be resected were discharged with catheter.The serum levels of alt,GGT,ALP,TBIL and DBIL were significantly lower than those before operation(P<0.05).【Conclusion】Ultrasound guided PTCD is an important treatment for patients with hilar cholangiocarcinoma.Simple biliary drainage can improve the liver function,reduce jaundice and improve the quality of.life of patients,which has the promotion significance in the basic level hospital.