数字减影血管造影下经皮经肝胆管不同引流方式治疗高位恶性胆管梗阻的疗效对比

Comparison of clinical efficacy of different percutaneous drainage through hepatobiliary duct under digital subtraction angiography in the treatment of high level malignant bile duct obstruction

目的 分析数字减影血管造影下使用经皮肝胆管不同引流方式对高位恶性胆管梗阻患者的临床治疗效果。方法 将2020年1月—2021年12月郑州大学第一附属医院100例高位恶性胆管梗阻患者作为研究对象,以随机数字表法将其划分为参照与试验两组(n=50),分别给予胆管单支架植入并对侧外引流、双支架植入内引流两种引流治疗,分析两组患者的临床治疗效果。结果 试验组的治疗有效率(94.00%)高于参照组(80.00%),组间比较存在明显差异(P<0.05)。经过手术引流治疗前3 d和术后7 d,两组患者的各项主要的肝功能的组间比较均显示出均衡性特征(P>0.05);经过手术治疗之后,两组患者的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)指标均处于低于接受手术之前的水平,且试验组接受手术治疗后14d的各项肝功能指标数值较参照组低,组间比较显示出明显差异(P<0.05)。试验组患者的近期并发症发生率处在低于参照组的水平,组间比较存在明显差异(P<0.05)。结论 将PTCD应用于高位恶性胆管梗阻患者的治疗当中可发挥出较好效果,双支架或多支架的胆管内引流较单支架对侧外引流的效果要好,能够有效改善肝脏功能,恢复胆汁的循环,同时也可降低并发症的发生率,可有效提升患者生存质量,值得推广。

Objective To analyze the clinical therapeutic effect of different percutaneous drainage through hepatobiliary duct under digital subtraction angiography for patients with high malignant biliary obstruction.Methods From January 2020 to December 2021,100 patients with high malignant biliary obstruction were selected as study subjects and divided into two groups(n=50) by random number table method.Two kinds of drainage treatments were given:single stent implantation and contralateral external drainage,and double stent implantation and internal drainage.The clinical therapeutic effects of the two groups were analyzed.Results The effective rate of the experimental group was higher than that of the reference group,and there was significant difference between the groups(P<0.05).After 3 days before and 7 days after surgical drainage,all the main liver functions of the two groups showed equilibrium characteristics(P>0.05).After surgery,the indexes of ALT,AST,TBIL and TBIL of the two groups were lower than those before surgery,and the values of various liver function indexes of the experimental group were lower than that of the reference group at 14 days after surgery,and the comparison between groups showed significant differences(P<0.05).The rate of recent complications in experimental group was lower than that of reference group,and there was significant difference between groups(P<0.05).Conclusion PTCD can play a good role in the treatment of patients with high malignant bile duct obstruction.The intrabile duct drainage with double or multiple stents has a better effect than the lateral external drainage with single stents,which can effectively improve liver function and restore bile circulation,reduce the incidence of complications,and effectively improve the quality of life of patients.It is worth promoting.