经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸近期效果观察及影响因素分析  

Short-term Efficacy Observation and Influencing Factor Analysis of Percutaneous Transhepatic Biliary Drainage in Treatment of Malignant Obstructive Jaundice

作　　者：王强[1] 赵丽莎[2] 柯要军[1] 张杰[1] 李杰[1] 

机构地区：[1]武汉科技大学附属天佑医院介入科,武汉430064 [2]武汉科技大学附属天佑医院消化内科,武汉430064

出　　处：《解放军医药杂志》2016年第2期55-58,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的观察经皮肝穿刺胆管引流术(PTBD)治疗恶性梗阻性黄疸的降黄效果,分析影响疗效的影响因素,为临床治疗方案制定提供理论依据。方法回顾分析武汉科技大学附属天佑医院2011年4月—2014年4月收治的122例恶性梗阻性黄疸患者的病例资料,患者均行PTBD,术后均跟踪随访,比较术前、术后1周总胆红素、直接胆红素、间接胆红素差异,收集患者性别、年龄、卡氏功能状态量表(KPS)评分、术前胆管扩张程度、术前肝功能、术前总胆红素水平、术前胆管感染、Bismush分型、术后并发症、梗阻部位、单双侧引流方式等可能影响降黄效果的因素资料,进行术后1周总胆红素与不同影响因素的单因素分析及logistic回归分析。结果 1治疗后1周总胆红素、直接胆红素、间接胆红素均显著低于治疗前(P<0.01),降黄效果显著87例(71.31%),降黄效果欠佳35例(28.69%),平均生存期为(11.60±2.15)个月。2单因素分析及Logistic回归分析显示,术前KPS评分、肝功能、总胆红素水平及术后并发症是影响降黄效果的主要因素(P<0.05,P<0.01)。结论 PTBD治疗恶性梗阻性黄疸效果确切,术前改善体能、积极保肝治疗、早期行PTBD及术后预防感染对改善预后具有重要意义。Objective To investigate the efficacy of percutaneous transhepatic biliary drainage （PTBD） in treatment of malignant obstructive jaundice （MOJ） , and to analyze the influencing factors of efficacy in order to provide theoretical basis for the clinical treatment. Methods Clinical data of 122 MOJ patients admitted during January 2010 and January 2014 was retrospectively analyzed, and all patients received PTBD, and then all were followed up after the surgery. The levels of total bilirubin （TB） , direct bilirubin and indirect bilirubin were compared before and 1 week after the surgery, and factor records such as gender, age, Karnofsky performance status （KPS） score, the values of cholangiecta- sis degree, liver function, TB and biliary tract infection before the surgery, Bismuth typing, and postoperative complications, obstruction positions, unilateral and bilateral drainage methods were collected, which might affect the efficacy. The single factor and logistic regression analyses were performed between TB and different influencing factors 1 week after the surgery. Results （1） One week after the surgery, the TB, direct bilirubin and indirect bilirubin levels were significantly lower than those before surgery （P 〈 0.01 ） , and there were 87 patients （71.31% ） with good efficacy and 35 patients （28.69%） with poor efficacy. The average survival time was （11.60± 2.15 ） month. （2） The single factor and Logistic regression analyses showed that the preoperative KPS score, liver function and TB level, and postoperative complications were the risk factors influencing the efficacy （ P 〈 0.05, P 〈 0. 01 ）. Conclusion The percutaneous transhepatic biliary drainage in treatment of malignant obstructive jaundice has obvious efficacy, and therefore it is significant to improve prognosis by preoperative improvement of physical ability, positive hepatoprotection therapy, early PTBD therapy and postoperative infection prevention.

关 键 词：恶性梗阻性黄疸 经皮肝穿刺胆管引流术 治疗结果 影响因素分析 

分 类 号：R575[医药卫生—消化系统] R735[医药卫生—内科学]