恶性梗阻性黄疸合并急性胆管炎患者术前胆道引流的效果观察  

Clinical application of preoperative biliary drainage in malignant obstructive jaundice with acute cholangitis

作　　者：陈秋恋[1] 吴珊珊[1] 刘朝辉[1] 

机构地区：[1]中国人民解放军第一八○医院普外科,福建泉州362000

出　　处：《临床肝胆病杂志》2015年第10期1652-1655,共4页Journal of Clinical Hepatology

基　　金：南京军区重点课题资助项目(10Z023)

摘　　要：目的探讨恶性梗阻性黄疸(MOJ)合并急性胆管炎(AC)患者术前胆道引流治疗在临床上的应用。方法回顾性研究2010年1月-2014年12月于中国人民解放军第一八○医院治疗的MOJ合并AC,且术前行胆道引流的64例患者的临床资料。其中29例行经皮经肝胆管引流术(PTCD)(称为PTCD组),35例内镜下胆管塑料支架引流术(ERBD)(称为ERBD组)。比较两组患者治疗前后TBil、DBil、ALT、住院总费用、平均住院时间和术后并发症等情况,对比两种术前胆道引流治疗的优缺点。计量资料的组间比较采用t检验,计数资料的组间比较采用χ2检验。结果治疗后两组患者的TBil、DBil、ALT水平均明显下降,差异均有统计学意义(P值均<0.05)。ERBD组的3个生化指标的下降水平较PTCD组更明显(P值均<0.05)。ERBD组平均住院时间较PTCD组短(t=3.172,P<0.05),且住院总费用比PTCD组更少(t=2.562,P<0.05)。ERBD组急性胰腺炎发生率较PTCD组高(25.7%vs 3.45%,P<0.05),胆道出血、胆道感染和切开或穿刺点感染发生率均较PTCD组低(P值均<0.05)。结论术前胆道引流能显著控制AC症状,改善肝功能,ERBD治疗较PTCD治疗住院时间短、住院总费用低、治疗后并发症发生率低,可作为MOJ合并AC的首选治疗方案。Objective To explore the clinical application of preoperative biliary drainage in the treatment of patients with malignant obstructive jaundice（ MOJ） with acute cholangitis（ AC）. Methods A retrospective study was performed on the clinical data of 74 patients with MOJ and AC who were treated with preoperative biliary drainage in our hospital from January 2010 to December 2014. In those patients,29 patients treated with percutaneous transhepatic biliary drainage（ PTCD） were assigned to PTCD group,and 35 patients treated with endoscopic retrograde biliary drainage（ ERBD） were assigned to ERBD group. The levels of total bilirubin（ TBil）,direct bilirubin（ DBil）,and alanine aminotransferase（ ALT） before and after treatment,total hospitalization cost,average duration of hospitalization,and postoperative complications were compared between the two groups. The advantages and disadvantages were compared between the two preoperative biliary drainage approaches. Between- group comparison of continuous data was made by t test,and between- group comparison of categorical data was made by χ2test. Results In both groups,the levels of TBil,DBil,and ALT were significantly reduced after treatment（ all P〈0. 05）.The ERBD group had significantly larger decreases in the levels of the three biochemical indices than the PTCD group（ all P〈0. 05）. The ERBD group had significantly shorter average duration of hospitalization and significantly lower total hospitalization cost than the PTCD group（ t = 3. 172,P〈0. 05; t = 2. 562,P〈0. 05）. The incidence of acute pancreatitis in the ERBD group was significantly higher than that in the PTCD group（ 14. 28% vs 3. 45%,P〈0. 05）; however,the incidence rates of biliary tract bleeding,biliary tract infection,and resection or puncture site infection were significantly lower in the ERBD group than in the PTCD group（ all P〈0. 05）. Conclusion Preoperative biliary drainage can substantially control AC symptoms and improve liver function. Compared wi

关 键 词：黄疸 阻塞性 胆管炎 内窥镜检查 消化系统 引流术 

分 类 号：R657.45[医药卫生—外科学]