不同路径行经皮肝穿刺胆管支架置入及置管引流术治疗中低位胆管梗阻的疗效比较

Comparison of the Efficacy of Percutaneous Hepatocentesis Biliary Stent Implantation and Catheter Drainage in the Treatment of Middle and Low Biliary Obstruction by Different Routes

目的 探讨不同路径行经皮肝穿刺胆管支架置入及置管引流术治疗中低位胆管梗阻的疗效比较。方法 搜集2016年3月至2022年3月陕西省人民医院介入放射科行经皮肝穿刺胆管支架置入及置管引流术治疗中低位胆管梗阻的424例患者病历资料进行回顾性分析。按患者的穿刺路径分为剑突下肝左叶入路组(A组,224例)和右侧肋间肝右叶入路组(B组,200例)。比较两组患者手术后3天及术后1周肝功能改善情况、术后胆管出血发生率、术后疼痛持续时间、腹腔积液自引流管周围漏出情况,随访记录患者生存时间。结果 424例手术全部成功,无不良事件发生。其中A组224例,B组200例,A组与B组相比,基本资料差异无统计学意义(P>0.05);两组术后胆管出血发生率差异无统计学意义(P>0.05)。患者手术后1周总胆红素下降速率、直接胆红素下降速率、门冬氨酸氨基转移酶下降速率、γ-谷氨酰转肽酶手术后3天及1周下降速率A组显著快于B组(P<0.05)。腹腔积液自引流管周围漏出情况A组明显少于B组(P<0.05)。患者生存率A组高于B组(P<0.05)。结论 在治疗中低位胆管梗阻的黄疸患者中,经皮左肝穿刺路径的患者临床疗效要优于经皮右肝穿刺路径。

Objective To investigate the efficacy of percutaneous hepatocentesis biliary stent implantation and catheter drainage in the treatment of low and middle biliary obstruction.Methods From March 2016 to March 2022,medical records of 424 patients with middle and low biliary obstruction treated by percutaneous hepatocentesis biliary stent implantation and catheter drainage in interventional radiology Department of Shaanxi Provincial Peoples Hospital were retrospectively analyzed.Patients were divided into subxiphoid left lobe approach group(group A,224 cases)and right intercostal right lobe approach group(group B,200 cases)according to the puncture path.The improvement of liver function,incidence of postoperative biliary bleeding,duration of postoperative pain and leakage of abdominal fluid from around the drainage tube were compared between the two groups 3 days after surgery and 1 week after surgery,and the survival time of patients was followed up and recorded.Results All 424 cases were successfully operated without adverse events.There were 224 cases in group A and 200 cases in group B.There was no significant difference in basic data between group A and group B(P>0.05).There was no significant difference in the incidence of postoperative biliary bleeding between the two groups(P>0.05).The decrease rate of total bilirubin,direct bilirubin and aspartate aminotransferase 1 week after surgery;The decrease rate of-glutamyltranspeptidase 3 days and 1 week after operation was significantly faster in group A than in group B(P<0.05).Abdominal cavity effusion from drainage tube leakage situation around A set of significantly less than group B(P<0.05).Patient survival rate in group A than group B(P<0.05).The survival rate in group A was higher than that in group B(P<0.05).Conclusion In the treatment of jaundice patients with middle and low biliary obstruction,percutaneous left liver puncture is better than percutaneous right liver puncture.