恶性梗阻性黄疸患者经皮经肝胆管引流途径胆道支架置入与姑息性胆肠内引流的疗效比较  

Comparative efficacy of palliative biliary enteric extraction and percutaneous biliary stenting under ultrasound guidance in the treatment of malignant obstructive jaundice

作　　者：姚广力[1] 江怡[1] 赵云歆[1] 王颖[1] 梅将军[1] 王健 YAO Guang-li;JIANG Yi;ZHAO Yun-xin(Department of Ultrasound,Shanghai Pudong Hospital,Shanghai 200125,China)

机构地区：[1]上海市浦南医院超声科,上海200125 [2]上海市东方医院南院肝胆外科,上海200120

出　　处：《临床和实验医学杂志》2018年第22期2430-2433,共4页Journal of Clinical and Experimental Medicine

基　　金：上海市浦东新区科技发展基金(编号:PKJ2015-Y48)

摘　　要：目的探讨恶性梗阻性黄疸治疗中经皮经肝胆管引流途径胆道支架置入(PTCD)与姑息性胆肠内引流的疗效差异。方法选取上海市浦南医院2011年6月至2017年6月收治的204例随访资料完整的恶性梗阻性黄疸患者进行回顾性分析,按其手术方式分为支架组(118例)和引流组(86例)。支架组在超声引导下行经皮经肝胆管引流途径胆道支架置入术,引流组在胆囊切除术后行姑息性胆肠内引流。观察两组临床疗效、手术前后肝功能的变化、并发症及生存时间,从而比较两组的疗效差异。结果两种方法均能有效解除胆道梗阻、缓解症状;在黄疸程度和肝功能损伤更严重的情况下,支架组TBIL和DBIL的术后值分别为(77. 45±58. 84)μmol/L和(34. 91±27. 83)μmol/L,显著低于引流组的(98. 07±64. 64)μmol/L和(45. 71±33. 79)μmol/L,差异有统计学意义(P <0. 05);支架组术后支架通畅平均中位时间为10个月,生存平均中位时间为9个月;引流组术后生存平均中位时间为11个月。两组生存时间比较,差异无统计学意义(P> 0. 05)。结论对于无法达到根治性手术条件的恶性梗阻性患者,PTCD途径置入胆道支架可作为恶性梗阻性黄疸姑息性治疗的首选方法。Objective To compare the therapeutic effects of different palliative drainage way on the malignant obstructive jaundice patients who can not perform a surgical resection. Methods Clinical data of 204 malignant obstructive jaundice patients who could not perform a surgical resection were analyzed retrospectively, and the therapeutic effects of palliative internal drainage and percutaneous biliary stent were compared. Among them, biliary mental sents implantation hy the way of percutaneoas transhepatic cholangial drainage （PTCD） in 118 cases, Palliative biliary intestinal in drainage in 86 cases. Results Biliary obstruction was effectively relieved in both groups and the liver function was improved. In the physical condition, when jaundice and liver dysfunction were more severe, the results of TBIL and DBIL in the stent group were （77.45 ± 58.84 ）μmol/L and （34.91 ± 27.83 ） μmol/L, respectively, which were significantly lower than those in the drainage group which were （98.07 ± 64.64） μmol/L and （45.71 ± 33.79）μmol/L, respectively. The difference was statistically significant （ P 〈 0.05 ）. The mean median time of stent patency was 10 months and the mean median survival time was 9 months. The median survival time in the drainage group was 11 months. The difference of the postoperative survival time was not statistically significant （ P 〉 0.05 ）. Conclusion In the treatment of malignant obstructive jaundice patients who can not perform a surgical resection, biliary mental sents implantation is the first choice because it is simple, security, has less trauma and it is repeatability.

关 键 词：恶性梗阻性黄疸 经皮经肝胆管引流途径胆道支架置入 胆肠内引流 

分 类 号：R730.5[医药卫生—肿瘤]