超声引导下经皮肝穿刺胆道引流联合胆管复合支架置入术治疗晚期肝外胆管癌的效果

Ultrasound guided percutaneous transhepatic choledochus drainage combined biliary hybrid stent implantation in treatment of advanced extrahepatic cholangiocarcinoma

目的探讨超声及CT引导下经皮肝穿刺胆道引流(PTCD)联合胆管复合支架置入术治疗晚期肝外胆管癌的效果。方法将98例晚期肝外胆管癌患者按术前引导方式不同分为超声组(n=52)和CT组(n=46),两组均给予PTCD联合胆管复合支架置入术治疗,观察两组患者一次穿刺成功率、肝功能指标、并发症发生情况及生存情况。结果超声组患者一次穿刺成功率高于CT组,并发症总发生率低于CT组,差异均有统计学意义(P﹤0.05)。术前,超声组和CT组患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(ALP)水平比较,差异均无统计学意义(P﹥0.05);术后7天,两组患者ALT、AST、TBIL、DBIL和ALP水平均较术前降低(P﹤0.05),且超声组患者ALT、AST、TBIL、DBIL和ALP水平均明显低于CT组(P﹤0.01)。术前及术后7天,两组患者血清Na^(+)、K^(+)水平比较,差异均无统计学意义(P﹥0.05)。两组患者生存情况比较,差异无统计学意义(P﹥0.05)。结论相比较CT引导,超声引导下PTCD联合胆管复合支架置入术治疗晚期肝外胆管癌有较好的效果。

Objective To investigate the effect of ultrasound and CT guided percutaneous transhepatic choledochus drainage(PTCD)combined biliary stent implantation in the treatment of advanced extrahepatic cholangiocarcinoma.Method A total of 98 patients with advanced extrahepatic cholangiocarcinoma were divided into ultrasound group(n=52)and CT group(n=46)according to the preoperative guidance mode,both groups were given PTCD combined biliary hybrid stent implantation,the success rate of one-time puncture,liver function,complications and survival in the two groups were observed.Result The success rate of one-time puncture in ultrasound group was higher,the overall complication lower than those in CT group(P<0.05);There were no significant differences for the alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),direct bilirubin(DBIL)and alkaline phosphatase(ALP)between the two groups before surgery(P>0.05);the levels of ALT,AST,TBIL,DBIL and ALP in both groups decreased 7 days after surgery(P<0.05),with lower levels in the ultrasound group than those in the CT group(P<0.01);there were no significant differences for the serum Na^(+)and K^(+)levels before and 7 days after surgery between the two groups(P>0.05);there was no significant difference for the survival between the two groups(P>0.05).Conclusion The effect of ultrasound guided PTCD combined biliary hybrid stent implantation is superior to CT method in the treatment of advanced extrahepatic cholangiocarcinoma.