超声定位引导下经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸患者的疗效及安全性

Clinical efficacy and safety of ultrasound-guided percutaneous transhepatic cholangic drainage in treatment of malignant obstructive jaundice patients

目的探讨超声定位引导下经皮肝穿刺胆管引流术(percutaneous transhepatic cholangic drainage,PTCD)治疗恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)患者的临床疗效,以及对患者创伤性应激反应、肝功能、凝血功能的影响。方法选取濮阳市油田总医院2021年1月至2022年12月收治的124例MOJ患者,采用随机数字表法将患者分为常规PTCD组和超声引导下PTCD组,各62例。超声引导下PTCD组在超声定位引导下进行PTCD手术;常规PTCD组在常规的X线引导下进行PTCD手术。采用秩和检验比较两组临床疗效,采用独立样本t检验比较两组手术指标,采用配对样本t检验比较两组术前、术后不同时间点创伤应激指标,如血清去甲肾上腺素(NE)、皮质醇(Cor)、超敏C反应蛋白(hs-CRP),肝功能指标,如血清总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST),凝血功能指标,如活化部分的凝血活酶时间(APTT)、凝血酶原时间(PT),采用卡方检验比较两组并发症情况。结果术后2周,超声引导下PTCD组的临床总有效率为90.32%,略高于常规PTCD组的83.87%,但组间比较无显著性差异(P>0.05);超声引导下PTCD组手术用时明显短于常规PTCD组,一次性穿刺成功率(95.16%)明显高于常规PTCD组(59.68%)(P<0.05);术后3 d和术后1周,两组血清Cor、NE、hs-CRP水平均呈先升高后降低的趋势,且超声引导下PTCD组血清Cor、NE、hs-CRP水平波动幅度小于常规PTCD组(P<0.05);术后1周,超声引导下PTCD组血清ALT、AST、TBil、DBil水平明显低于常规PTCD组,而PT、APTT明显高于常规PTCD组(P<0.05)。结论超声定位引导下PTCD手术与常规X线PTCD手术均有较好的临床疗效,但超声定位引导下PTCD手术用时更短,一次性穿刺成功率和手术安全性更高,且可进一步减轻手术创伤性应激反应,改善患者的肝功能和凝血功能,有助于术后快速恢复。

Objective To investigate the clinical efficacy of ultrasound-guided percutaneous transhepatic cholangic drainage(PTCD)in the treatment of malignant obstructive jaundice(MOJ)and its effects on traumatic stress response,liver function and coagulation function.Methods Totally 124 patients with MOJ in the Puyang Oilfield General Hospital from January 2021 to December 2022 were selected and divided into conventional PTCD group(n=62)and ultrasound-guided PTCD group(n=62).Ultrasound-guided PTCD group underwent PTCD operation under ultrasound guidance.The conventional PTCD group underwent PTCD surgery under the guidance of conventional X-ray.The clinical efficacy of the two groups was compared by rank-sum test,surgical indexes of the two groups was compared by independent sample t test,traumatic stress indexes[serum cortisol(Cor),norepinephrine(NE)and hypersensitive C-reactive protein(hs-CRP)],liver function indexes[serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBil),direct bilirubin(DBil)] and coagulation function indexes[prothrombin time(PT)and activated thrombin time(APTT)] at different time points before and after surgery were compared by paired sample t test,and complications of the two groups were compared by Chi-square test.Results After 2 weeks of operation,the total clinical effective rate of Ultrasound-guided PTCD group was 90.32%,which was slightly higher than that of conventional PTCD group 83.87%,but there was no significant difference(P>0.05).The operation time of ultrasound-guided PTCD group was significantly shorter than that of conventional PTCD group,and the success rate of one-time puncture(95.16%)was significantly higher than that of conventional PTCD group(59.68%)(P<0.05).After 3 days and 1 weeks of operation,serum levels of Cor,NE and hs-CRP in both groups presented a trend of first increase and then decrease,and the fluctuation range of serum levels of Cor,NE and hs-CRP in ultrasound-guided PTCD group was lower than that in conventional PTCD group(P<0.05).After 1 week of operation,the levels of ALT,AST,TBil and DBil in the ultrasound-guided PTCD group were significantly lower than those in the conventional PTCD group,while the levels of PT and APTT were significantly higher than those in the conventional PTCD group(P<0.05).Conclusion Both ultrasound-guided PTCD surgery and conventional X-ray PTCD surgery have good clinical efficacy,but ultrasound-guided PTCD surgery takes a shorter time,has a higher success rate and surgical safety,and can further reduce the traumatic stress reaction of surgery,improve the liver function and coagulation function of patients,and contribute to rapid postoperative recovery.