内镜超声下肝胃造瘘引流术在高位恶性梗阻性黄疸中的应用价值  

Therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy for high malignant biliary obstructive jaundice

作　　者：赵旋 朱苏敏[2] 缪林[2] 石丽红 汪晓红 王艳斌 王金臣 郭思明 Zhao Xuan;Zhu Sumin;Miao Lin;Shi Lihong;Wang Xiaohong;Wang Yanbin;Wang Jinchen;Guo Siming(Department of Gastroenterology,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;Department of Gastroenterology,The Second Affiliated Hospital of Nanjing Medical University,Nanjig 210000,China)

机构地区：[1]徐州医科大学第二附属医院消化科,221000 [2]南京医科大学第二附属医院消化科,210000

出　　处：《中华消化内镜杂志》2019年第9期676-681,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜超声下肝胃造瘘引流术(EUS-HG)在高位恶性梗阻性黄疸患者中的应用价值。方法选取2014年1月至2017年12月在南京医科大学第二附属医院及徐州医科大学第二附属医院住院治疗的高位恶性梗阻性黄疸患者56例,其中男29例、女27例,中位年龄72岁。根据随机数字表随机将患者分为两组:EUS-HG组(20例),应用EUS-HG治疗;经皮经肝穿刺胆管引流术(PTCD)组(36例),应用PTCD治疗。对比两组患者的手术成功率、疗效、并发症、手术费用及观察塑料双猪尾支架的中位畅通期。结果(1)两组患者的操作成功率均为100.0%。(2)术前及术后1个月时,总胆红素(TBIL)在EUS-HG组为(362.15±138.27)、(56.85±28.57)μmol/L,在PTCD组为(356.47±130.69)、(60.93±25.79)μmol/L;碱性磷酸酶(ALP)在EUS-HG组为(896.57±357.29)、(146.59±48.63)U/L,在PTCD组为(883.65±364.32)、(151.57±49.73)U/L;谷丙转氨酶(ALT)在EUS-HG组为(252.36±38.77)、(60.29±31.57)U/L,在PTCD组为(246.26±32.57)、(62.56±32.87)U/L;谷草转氨酶(AST)在EUS-HG组为(259.37±30.64)、(62.28±26.58)U/L,在PTCD组为(242.37±29.52)、(60.28±29.57)U/L,组间下降水平差异均无统计学意义(P>0.05)。术前及术后1个月时,C反应蛋白(CRP)在EUS-HG组为(52.57±31.95)、(16.95±8.77)mg/L,在PTCD组为(53.42±35.79)、(25.13±14.77)mg/L,组间下降水平差异有统计学意义(P<0.05)。(3)纳差、腹胀症状缓解率,EUS-HG组80.0%(16/20)和PTCD组52.8%(19/36)比较,差异有统计学意义(P<0.05)。黄疸、皮肤瘙痒、腹痛症状缓解率,EUS-HG组90.0%(18/20)和PTCD组91.7%(33/36)比较,差异无统计学意义(P>0.05)。(4)EUS-HG组总并发症发生率20.0%(4/20)低于PTCD组47.2%(17/36),差异有统计学意义(P<0.05)。(5)EUS-HG组手术花费(22 685.26±2 356.16)元稍高于PTCD组(20 529.57±4 135.63)元,差异无统计学意义(P>0.05)。(6)随访EUS-HG组患者双猪尾塑料支架中位畅通期为102 d。结论EUS-HG疗效确切、并发症发生率低,是一种安全�Objective To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy(EUS-HG) for patients with high malignant biliary obstructive jaundice. Methods A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group (n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge(PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed. Results (1)The success rates were 100% in both groups.(2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362.15±138.27 μmol/L, 56.85±28.57 μmol/L in the EUS-HG group and 356.47±130.69 μmol/L, 60.93±25.79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896.57±357.29 U/L, 146.59±48.63 U/L in the EUS-HG group and 883.65±364.32 U/L, 151.57±49.73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252.36±38.77 U/L, 60.29±31.57 U/L in the EUS-HG group and 246.26±32.57 U/L, 62.56±32.87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259.37±30.64 U/L, 62.28±26.58 U/L in the EUS-HG group and 242.37±29.52 U/L, 60.28±29.57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52.57±31.95 mg/L, 16.95±8.77 mg/L in the EUS-HG group and 53.42±35.79 mg/L, 25.13±14.77 mg/L in the PTCD group (P<0.05).(3)There was significant difference in remission rate of anorexia and abdominal distension between the t

关 键 词：黄疸 阻塞性 穿刺术 引流 体位 超声内镜肝胃造瘘 

分 类 号：R730.5[医药卫生—肿瘤]