晚期肝门部胆管癌减黄治疗的对比研究  

Comparative study of reducing jaundice treatment of advanced hilar cholangiocarcinoma

作　　者：张东[1] 陶杰[1] 白纪刚[1] 石磊[1] 孙昊[1] 王林[1] 耿智敏[1] Zhang Dong;Tao Jie;Bai Jigang;Shi Lei;Sun Hao;Wang Lin;Geng Zhimin(Department of Hepatobiliary Surgery,First Affiliated Hospital of Medical College,Xi＇an Jiaotong University,Xi＇an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华腔镜外科杂志（电子版）》2017年第5期311-314,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81572420)

摘　　要：目的探讨内镜逆行胰胆管造影(ERCP)和经皮肝穿刺胆道引流(PTCD)对晚期肝门部胆管癌的减黄治疗效果及差异。方法回顾性分析2003年1月至2013年12月西安交通大学第一附属医院肝胆外科收治的113例晚期肝门部胆管癌患者的临床资料。其中男63例,女50例;年龄29~83岁;分析减黄治疗及效果、术后并发症及患者生存情况。结果 ERCP+胆道支架置入42例(ERCP组),行PTBD术71例(PTBD组)。在整体减黄治疗中,ERCP组和PTBD组有效减黄率分别为85.7%和85.9%,两组间差异无统计学意义(P>0.05)。ERCP组术后胆管炎发生率为38.1%,显著高于PTBD组的14.1%(P<0.01);ERCP组术后胆道出血发生率为2.4%,PTBD组为15.5%,两组间差异有统计学意义(P<0.01);ERCP组术后肝功能衰竭发生率为9.5%,PTBD组为14.1%,两组间差异无统计学意义(P>0.05)。PTBD组的中位生存时间为7个月,与放弃治疗患者的中位生存时间3个月比较,显著延长患者生存时间;ERCP组与PTBD组之间差异无统计学意义(P>0.05)。结论提高晚期肝门部胆管癌的诊治效果并改善生存治疗,需要有效的减黄治疗,可改善患者生存时间;其中首选ERCP减黄治疗,可改善患者术后生存质量。Objective To investigate the efficacy and difference of endoscopic retrograde cholangio pancreatography（ERCP） and percutaneous transhepatic biliary- drainage （PTBD） in the treatment of advanced hilar cholangiocarcinoma. Methods The clinical data of 113 patients with hilar cholangiocarcinoma admitted to the department of hepatobiliary- surgery- of the First Affiliated Hospital of Xi＇ an Jiao Tong University- from Jan. 2003 to Dec. 2013 were retrospectively analyzed. All patients signed informed consent, in accordance with the provisions of medical ethics. There were 63 males and 50 females, average age 29-83 years old. Analysis of the treatment and the effect of reducing jaundice, postoperative complications and patient survival. Results In 113 patients with advanced hilar cholangiocarcinoma, 42 cases were treated with ERCP ＋ biliary- stent implantation and 71 cases with PTBD. In the overall subtraction therapy, the effective yellow rate in ERCP and PTBD groups was 85. 7% and 85. 9%, respectively, and there was no significant difference between the two groups （P 〉 0.05）. ERCP group of postoperative cholangitis incidence rate was 38.1% , significantly higher than 14.1% in group PTBD （P 〈 0.01 ） ; the incidence of 2.4% biliary- tract hemorrhage after operation in ERCP group, PTBD group was 15.5% , there was significant difference among the two groups （P 〈 0.01 ） ; ERCP group of postoperative liver failure occurred in 9.5% , 14. 1% in PTBD group, no see a significant difference between the two groups （P 〉 0.05）. The results of jaundice treatment for 7 months, and give up 3 months of treatment group was significantly prolonged the survival time of the patients; there was no significant difference between ERCP group and PTBD group （ P 〉 0. 05 ）. Conclusions To improve the diagnosis and treatment of advanced hilar cholangiocarcinoma and improve survival therapy, effective jaundice reduction treatment is needed to improve the survival time of patients. The first choice of ERCP re

关 键 词：肝门部胆管癌 减黄治疗 预后 

分 类 号：R735.8[医药卫生—肿瘤]