PTBD联合体外辅助胆汁入肠治疗恶性梗阻性黄疸患者疗效研究

Percutaneous transhepatic biliary drainage and auxiliary bile entering to gut in the treatment of patients with malignant obstructive jaundice

目的观察采用经皮肝穿刺胆道引流(PTBD)联合体外辅助胆汁入肠治疗恶性梗阻性黄疸患者的疗效。方法2019年9月~2022年9月我院诊治的恶性梗阻性黄疸患者100例(其中胆管细胞癌42例、胰头癌35例、胆囊癌23例),被随机分为对照组50例和观察组50例,分别采用单纯的PTBD治疗或在PTBD治疗的基础上,联合体外辅助胆汁入肠治疗。使用PUZS-600A型全自动生化分析仪检测血生化指标。结果在治疗2周后,观察组体质指数、血钠、血钾和血清白蛋白水平分别为(20.3±2.2)kg/m^(2)、(144.8±14.6)mmol/L、(4.6±0.5)mmol/L和(35.2±4.2)g/L,显著高于对照组[分别为(16.9±1.8)kg/m^(2)、(138.2±10.7)mmol/L、(4.3±0.4)mmol/L和(30.1±4.9)g/L,P<0.05];观察组血清TBIL、AST、ALT和GGT水平分别为(142.5±34.5)μmol/L、(42.7±18.6)U/L、(45.9±12.9)U/L和(215.2±74.3)U/L,显著低于对照组[分别为(172.3±36.8)μmol/L、(58.4±14.4)U/L、(62.35±17.8)U/L和(271.9±62.1)U/L,P<0.05];术后,观察组出现5例胆汁外渗、8例置管部位疼痛、1例腹泻、1例胆汁性腹膜炎,对照组出现6例胆汁外渗、11例置管部位疼痛、3例胆汁性腹膜炎,两组并发症发生率无显著性统计学差异(30.0%对40.0%,P>0.05)。结论采用PTBD联合体外辅助胆汁入肠治疗恶性梗阻性黄疸患者有利于短期改善营养状况和肝功能指标,作为姑息治疗,值得临床应用。

Objective The aim of this study was to observe the alleviative treatment of percutaneous transhepatic biliary drainage(PTBD)and auxiliary bile entering to gut in treatment of patients with malignant obstructive jaundice.Methods A total of 100 patients with malignant obstructive jaundice,including bile duct cancer in 42 cases,pancreatic cancer in 35 cases and gallbladder cancer in 23 cases,were encountered in our hospital between September 2019 and September 2022,and were randomly divided into control group(n=50)and observation group(n=50),receiving PTBD alone,or the auxiliary bile entering to gut at base of PTBD treatment.Blood parameters were detected by PUZS-600A automatic biochemical analyzer.Results At the end of two week treatment,the body mass index,blood sodium,blood potassium and serum albumin levels in the observation group were(20.3±2.2)kg/m^(2),(144.8±14.6)mmol/L,(4.6±0.5)mmol/L and(35.2±4.2)g/L,significantly higher than[(16.9±1.8)kg/m^(2),(138.2±10.7)mmol/L,(4.3±0.4)mmol/L and(30.1±4.9)g/L,respectively,P<0.05]in the control;serum bilirubin,aspartate aminotransferase,alanine aminotransferase and glutamyl transpeptidase levels in the observation group were(142.5±34.5)μmol/L,(42.7±18.6)U/L,(45.9±12.9)U/L and(215.2±74.3)U/L,all significantly lower than[(172.3±36.8)μmol/L,(58.4±14.4)U/L,(62.35±17.8)U/L and(271.9±62.1)U/L,respectively,P<0.05]in the control;post-operationally,there were bile exosmosis in 5 cases,local catheterization site pain in 8 cases,diarrhea in 1 case and biliary peritonitis in 1 case in the observation group,and there were bile exosmosis in 6 cases,local catheterization site pain in 11 cases and biliary peritonitis in 3 cases in the control,without significant difference between the two groups(30.0%vs.40.0%,P>0.05).Conclusion The application of PTBD and auxiliary bile entering to gut in the treatment of patients with malignant obstructive jaundice could relief transiently hyperbilirubinemia and improve the nutritional status,which warrants further clinical investigation.