经皮肝穿刺胆道引流术在肝门部胆管癌治疗中的应用研究

Application of percutaneous transhepatic biliary drainage in treatment of hilar cholangiocarcinoma

目的探究经皮肝穿刺胆道引流术(PTCD)在肝门部胆管癌(HCCA)治疗中的应用效果。方法选择2017年11月—2019年5月本院收治的82例HCCA患者,依据手术方法不同分为PTCD组及经内镜鼻胆管引流术(ENBD)组,各41例。PTCD组行PTCD治疗,ENBD组行ENBD治疗。对比两组术后2年生存率与平均生存时间、治疗前后肝功能指标水平[总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)]及并发症。结果治疗后,PTCD组TBil、ALT、ALP水平为(196.45±18.59)mmol/L、(32.16±7.28)U/L、(170.46±46.82)U/L均低于ENBD组的(206.83±17.56)mmol/L、(36.89±8.75)U/L、(198.86±50.34)U/L(t=2.599、2.661、2.645,P=0.011、0.009、0.010);Ⅰ型、Ⅱ型患者治疗前后TBil水平对比,差异无统计学意义(t=1.318、1.723,P=0.217、0.095);Ⅲ型、Ⅳ型患者治疗后TBil水平分别为(221.01±21.68)mol/L、(241.44±22.97)mol/L低于治疗前的(262.35±25.47)mol/L、(301.49±28.53)mol/L(t=4.099、4.637,P值均<0.01);PTCD组平均生存时间[14.19(12.892,16.093)]个月,高于ENBD组[12.78(10.726,14.055)]个月(χ^(2)=23.514,P<0.01)。结论 PTCD治疗肝门部胆管癌(HCCA)引流量较高,具有安全性高、创伤小、并发症少等优势,有助于及时改善肝功能,延长生存时间,值得推广应用。

Objective To explore the effect of percutaneous transhepatic biliary drainage(PTBD) in the treatment of hilar cholangiocarcinoma(HCCA).Methods A total of 82 patients with HCCA treated in our hospital from November 2017 to May 2019 were divided into a PTBD group and an endoscopic nasobiliary drainage(ENBD) group,with 41 cases in each group.The PTBD group was treated with PTBD and the ENBD group with ENBD.The 2-year survival rate,mean survival time,liver function indexes [total bilirubin(TBIL),alanine aminotransferase(ALT),and alkaline phosphatase(ALP)] and complications before and after the treatment were compared between the two groups.Results After the treatment,the levels of TBIL,ALT and ALP in the PTBD group were(196.45±18.59) mol/L,(32.16±7.28) U/L,and(170.46±46.82) U/L respectively,which were lower than those in the ENBD group:(206.83±17.56) mol/L,(36.89±8.75) U/L,and(198.86±50.34) U/L respectively(t=2.599,2.661,2.645,P=0.011,0.009,0.010).There were no significant differences in TBIL levels between type Ⅰ and type Ⅱ patients before and after the treatment(t=1.318,1.723,P=0.217,0.095).After the treatment,the levels of TBIL in type Ⅲ and type Ⅳ patients were(221.01±21.68) mol/L and(241.44±22.97) mol/L respectively,lower than those before the treatment:(262.35±25.47) mol/L and(301.49±28.53) mol/L respectively,and the differences were statistically significant(t=4.099,4.637,both P <0.01).The mean survival time of the PTBD Group was [14.19(12.892-16.093)] months,which was significantly higher than that of the ENBD Group:[12.78(10.726-14.055)] months(χ^(2)=23.514,P <0.01).Conclusion PTBD in the treatment of HCCA has the advantages of high drainage volume,high safety,less trauma and fewer complications.It is helpful to improve the liver function and prolong the survival time.It is worthy of popularization and application.