术前PTCD在肝门部胆管癌围术期中的价值  

The value of preoperative PTCD in perioperative period of hilar holangiocarcinoma

作　　者：沈洪哲 贺鸣 杨浩[1] 辛少博 董亚东 秦兴雷 SHEN Hong⁃Zhe;HE Ming;YANG Hao(Department of Hepatobiliary Surgery,Henan University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院河南省人民医院肝胆胰腺外科,郑州450003

出　　处：《肝胆外科杂志》2022年第4期262-265,共4页Journal of Hepatobiliary Surgery

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ202102023);河南省科技攻关(222102310051)

摘　　要：目的探讨术前经皮肝穿刺胆道引流术(PTCD)在肝门部胆管癌围术期中的价值。方法回顾性分析河南大学人民医院2017年1月1日至2020年12月31日收治的102例肝门部胆管癌患者的临床资料,根据是否行术前PTCD分为PTCD组和NPTCD组。PTCD组32例,男18例,女14例,NPTCD组70例,男41例,女29例。比较两组患者术前术后肝功能、术中相关指标、术后并发症、长期生存率的差异。结果PTCD组患者入院时总胆红素明显高于NPTCD组(P<0.01);PTCD组术前总胆红素明显低于入院时总胆红素(P<0.01);PTCD组患者术后7天ALT低于NPTCD组(P<0.05),两组患者术后AST、总胆红素、白蛋白比较差异均无统计学意义(P>0.05);PTCD组住院时间长于NPTCD组(P<0.01),手术时间、术中出血、术中输血差异无统计学意义(P>0.05);PTCD组患者术后腹腔感染少于NPTCD组(P<0.05),其余术后并发症发生率差异无统计学意义(P>0.05);两组患者总体生存率比较差异无统计学意义(P>0.05)。结论术前PTCD减黄能够提高肝门部胆管癌患者的手术切除率,降低术后并发症的发生率,是一种有效的、安全的、可行的方法。Objective To explore the value of preoperative percutaneous transhepatic biliary drainage(PTCD)in the perioperative period of hilar cholangiocarcinoma.Methods The clinical data of 102 patients with hilar cholangiocarcinoma admitted to Henan University People’s Hospital from January 1,2017 to December 31,2020 were retrospectively analyzed.They were divided into PTCD group and NPTCD group according to the preoperative PTCD.There were 32 cases in PTCD group,18 males and 14 females,and 70 cases in NPTCD group,41 males and 29 females.The differences of liver function,intraoperative related indexes,postoperative complications and long-term survival rate between the two groups were compared.Results The total bilirubin in PTCD group was significantly higher than that in NPTCD group(P<0.01).The total bilirubin before operation in PTCD group was significantly lower than that at admission(P<0.01).7 days after operation,ALT in PTCD group was lower than that in NPTCD group(P<0.05),and there was no significant difference in AST,total bilirubin and albumin between the two groups(P>0.05).The hospital stay in PTCD group was longer than that in NPTCD group(P<0.01),and there was no significant difference in operation time,intraoperative bleeding and intraoperative blood transfusion(P>0.05).Postoperative abdominal infection in PTCD group was less than that in NPTCD group(P<0.05),and there was no significant difference in other postoperative complications(P>0.05).There was no significant difference in overall survival rate between the two groups(P>0.05).Conclusion Preoperative PTCD is an effective,safe and feasible method that can improve the surgical resection rate and reduce the incidence of postoperative complications in patients with hilar cholangiocarcinoma.

关 键 词：肝门部胆管癌 PTCD 治疗效果 

分 类 号：R735.8[医药卫生—肿瘤]