经皮肝穿刺胆道引流术引流管置入胆道对恶性梗阻性黄疸患者肝功能及近期预后的影响研究

The effect of percutaneous transhepatic biliary drainage with drainage tube placementon liver function and short-term prognosis in patients with malignant obstructive jaundice

目的探讨经皮肝穿刺胆道引流术(PTBD)引流管置入胆道对恶性梗阻性黄疸(MOJ)患者肝功能及近期预后的影响。方法选取2021年1—12月于上饶东信第五医院肝胆胰外科就诊的60例MOJ患者作为研究对象,根据不同治疗方式分为PTBD组(n=33)与对照组(n=27)。PTBD组给予PTBD介入治疗,对照组给予常规开腹引流。比较两组肝功能指标[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)]、细胞免疫水平[CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)]、临床疗效、术后并发症发生情况及随访不良预后情况。结果术后7 d,两组血清AST、ALT、TBIL、DBIL、IBIL水平均低于术前,且PTBD组低于对照组,差异有统计学意义(P<0.05)。术后7 d,PTBD组CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均高于术前、对照组,差异有统计学意义(P<0.05),对照组CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)手术前后比较差异无统计学意义。PTBD组治疗总有效率为90.91%,高于对照组的66.67%,差异有统计学意义(P<0.05)。两组术后并发症及不良预后发生率比较差异无统计学意义。结论PTBD引流管置入胆道临床疗效显著,可明显恢复MOJ患者肝功能,改善患者免疫水平,改善近期预后。

Objective To investigate the effect of percutaneous transhepatic biliary drainage with drainage tube placement on liver function and short-term prognosis in patients with malignant obstructive jaundice(MOJ).Methods A total of 60 patients with MOJ who were treated in the department of Hepatobiliary and Pancreatic Surgery of Shangrao Dongshin Fifth Hospital from January 2021 to December 2021 were selected as the study subjects,and they were divided into the PTBD group(n=33)and the control group(n=27)according to different treatment methods.PTBD group received PTBD interventional treatment,control group received routine open drainage.The liver function indicators(aspartate aminotransferase[AST],alanine aminotransferase[ALT],total bilirubin[TBIL],direct bilirubin[DBIL],indirect bilirubin[IBIL]),cellular immune levels(CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)),clinical efficacy,the postoperative complications and poor prognosis were compared between the two groups.Results 7 d after operation,the levels of serum AST,ALT,TBIL,DBIL and IBIL water of the two groups were lower than before operation,and the PTBD group was lower than the control group,the differences were statistically significant(P<0.05).7 d after operation,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the PTBD group were higher than those before operation and the control group,and the differences were statistically significant(P<0.05),there were no significant differences in CD3^(+),CD4^(+)levels and CD4^(+)/CD8^(+)in the control group before and after operation.The total effective rate in the PTBD group was 90.91%,which was higher than 66.67%in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in incidence of postoperative complications and poor prognosis between the two groups.Conclusion PTBD drainage tube implantation into the biliary tract has significant clinical effect,which can significantly restore liver function,improve the immune level of patients with MOJ,and improve the short-term prognosis.