一站式超声诊疗模式诊治晚期恶性梗阻性黄疸的临床效果

Clinical effect of one-stop ultrasound diagnosis and treatment mode in the diagnosis and treatment of advanced malignant obstructive jaundice

目的探讨应用一站式超声诊疗模式诊治晚期恶性梗阻性黄疸(MOJ)的临床效果。方法选取2020年1月—2021年12月衡水市人民医院收治的200例晚期MOJ患者,按照随机数字表法分组,每组各100例。对照组采取X线引导经皮经肝胆道穿刺(PTCD),观察组采取一站式超声诊疗模式。统计两组围术期指标、并发症及手术前后体液免疫[免疫球蛋白A(IgA)、免疫球蛋白(GIgG)、免疫球蛋白M(IgM)]、纤溶-凝血指标[凝血酶原时间(PT)、纤维蛋白原(FIB)、组织型纤溶酶原激活物(tPA)]、肝脏功能[总胆红素(TBIL)、白蛋白(ALB)、直接胆红素(DBIL)]。结果观察组一次性置管成功率及黄疸缓解率较对照组高,透视时间较对照组短(P<0.05);术后1d观察组血清IgG、IgA、IgM及PT、tPA水平高于对照组,FIB水平低于对照组(P<0.05);术后1 d、1个月观察组TBIL、ALB、DBIL水平低于对照组(P<0.05);观察组并发症总发生率较对照组低(P<0.05)。结论一站式超声诊疗模式有助于提高晚期MOJ患者一次性置管成功率,缓解黄疸,改善肝功能,减少并发症,且对体液免疫、纤溶-凝血指标影响较小。

Objective To investigate the effect of one-stop ultrasound diagnosis and treatment mode on fibrinolysis-coagulation indexes and humoral immunity in patients with advanced malignant obstructive jaundice(MOJ).Methods 200 patients with advanced MOJ admitted to Hengshui People's Hospital from January 2020 to December 2021 were selected and grouped by random number table method,100 cases each.In the control group,X-ray-guided percutaneous transhepatic cholangio drainage(PTCD)was adopted,and in the observation group,one-stop ultrasound treatment mode was adopted.Perioperative indicators,complications and before and after operative humoral immunity[Immunoglobulin A(IgA),Immunoglobulin G(IgG),Immunoglobulin M(IgM)],fibrinolytic-coagulation indicators[Prothrombin time(PT),Fibrinogen(FIB),tissue-type fibrinogen activator(tPA)],fibrinogen and tPA were counted in both groups.Prothrombin time(PT),fibrinogen(FIB),tissue-type plasminogen activator(tPA).liver function[total bilirubin level(TBIL),albumin(ALB),tPA].(Albumin,ALB),Direct bilirubin(DBIL).Results The success rate of one-time catheter intubation and jaundice remission rate in the observation group were higher than those in the control group,and the fluoroscopy time was shorter than that in the control group(P<0.05).The levels of serum IgG,IgA,IgM,PT and tPA in the observation group were higher than those in the control group 1 day after operation.The levels of FIB in the observation group were lower than those in the control group(P<0.05);The levels of TBIL,ALB and DBIL in the observation group were lower than those in the control group 1 day and 1 month after operation(P<0.05);The total incidence of complications in the observation group was higher than that in the control group.low(P<0.05).Conclusion The one-stop ultrasound diagnosis and treatment model can help to improve the success rate of one-time catheterization in patients with advanced MOJ,relieve jaundice,improve liver function,and reduce complications,and has little effect on humoral immunity and fibrinolysis-coagulation indexes.