DSA介导下经皮肝穿胆道引流(PTBD)联合胆道支架植入术与传统手术治疗恶性胆道梗阻的安全性及疗效  

The Safety and Efficacy of DSA-mediated Percutaneous Transhepatic Bile Duct Drainage(PTBD) Combined with Biliary Stent Implantation and Traditional Surgery in the Treatment of Malignant Biliary Obstruction

作　　者：王清泉 WANG Qing-quan(Department of General Surgery,Lubei High and New Technology Development Zone People’s Hospital,Binzhou,Shandong Province,251900 China)

机构地区：[1]鲁北高新技术开发区人民医院普外科,山东滨州251900

出　　处：《中外医疗》2018年第4期43-46,共4页China & Foreign Medical Treatment

摘　　要：目的评价DAS介导下PTBD联合胆道支架植入、传统手术治疗恶性胆道梗阻的疗效与安全性。方法回顾性分析2011年2月—2015年2月医院收治的姑息治疗恶性胆道梗阻患者入组,其中方便选择传统经内镜逆行胰胆管造影置管引流手术对象76例纳入对照组,同期方便选择DSA介导下经皮肝穿胆道引流(PTBD)联合胆道支架植入术51例纳入观察组。对比手术、引流、住院情况以及预后、并发症发生情况。结果观察组术中出血量、引流时间分别为(34.4±6.5)m L、(17.4±8.6)d,对照组分别为(51.4±8.3)m L、(22.8±8.4)d,观察组优于对照组,差异有统计学意义(P<0.05),两组手术时间、住院时间差异无统计学意义(P>0.05)。观察组术后1周总胆红素下降幅度、黄染控制时间、术后1周KPS评分、支架通畅时间分别为(46.6±15.6)%、(4.7±1.5)d、(72.5±11.5)分、(6.2±0.5)个月、(5.6±13.5)个月、对照组分别为(33.8±12.9)%、(7.5±1.8)d、(70.2±13.6)分、(5.8±0.3)个月、(4.6±12.5)个月,两组差异有统计学意义(P<0.05)。观察组并发症合计发生率为54.9%,低于对照组的72.4%,差异有统计学意义(P<0.05)。结论 DSA介导下经皮肝穿胆道引流(PTBD)联合胆道支架植入术相较于传统手术,引流、降黄效果更好,还可降低并发症发生风险。Objective This paper tries to evaluate the efficacy and safety of DAS-mediated PTBD combined with biliary stent implantation and traditional surgical in treatment of malignant biliary obstruction.Methods From February 2011 to February 2015,the data of palliative treatment of malignant biliary obstruction were retrospectively analyzed.Among them,76 cases were treated by endoscopic retrograde cholangiopancreatography,and were included in the control group.At the same time,51 patients with percutaneous transhepatic bile duct drainage(PTBD)and biliary tract stent implantation were convenient selected and were divided into observation group,comparison of surgery,drainage,hospitalization and prognosis,complications occurred of the two groups.Results The blood loss,drainage time in observation group were(34.4±6.5)mL,(17.4±8.6)d,control group were(51.4±8.3)mL,(22.8±8.4)d,the observation group was better than the control group and the difference was significant(P<0.05).There was no significant difference in operation time and hospitalization time between the two groups(P>0.05).1 week after the reduction of total bilirubin,stained yellow control time,postoperative 1 week KPS score,stent patency of observation group were(46.6±15.6)%,(4.7±1.5)d,(72.5±11.5)points,(6.2±0.5)months,(5.6±13.5)months,control group were(33.8±12.9)%,(7.5±1.8)d,(70.2±13.6)points,(5.8±0.3)months,(4.6±12.5)months,there was significant difference between the two groups(P<0.05).The incidence of complications in the observation group was 54.9%,which was lower than that of the control group(72.4%),the difference was statistically significant(P<0.05).Conclusion DSA-mediated percutaneous transhepatic bile duct drainage(PTBD)combined with biliary stent implantation is more effective than traditional surgery,which has good effect in drainage and strained yellow dropping,and can reduce the risk of complications.

关 键 词：恶性胆道梗阻 DSA介导 经皮肝穿胆道引流 胆道支架植入 

分 类 号：R442[医药卫生—诊断学]