术前三种减黄方式对老年Ⅲ～Ⅳ型肝门部胆管癌的疗效分析  

Clinical analysis of preoperative biliary drainage for elderly patients with Ⅲ～Ⅳ hilar cholangiocarcinoma

作　　者：李光辉 要瞰宇 赵海平[1] 吕飞飞[2] Li Guanghui;Yao Kanyu;Zhao Haiping;Lyu Feifei(Department of Emergency surgery,the Affiliated hospital of Inner Mongolia medical university,Inner Mongolia 010050,China;Department of Hepatobiliary surgery,the Affiliated hospital of Inner Mongolia medical university,Inner Mongolia 010050,China)

机构地区：[1]内蒙古医科大学附属医院急诊外科,010050 [2]内蒙古医科大学附属医院肝胆外科,010050

出　　处：《中华普外科手术学杂志（电子版）》2019年第6期556-559,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：内蒙古自治区科技厅自然科学科技计划项目(201502073);内蒙古医科大学2017年一般科研计划项目(NYFYYB014)~~

摘　　要：目的对比老年Ⅲ~Ⅳ型肝门部胆管癌患者术前行内镜下放置鼻胆管引流(ENBD)、内镜下放置胆道内支架引流(ERBD)和经皮肝穿刺胆道引流(PTCD)三种不同减黄方式后的临床疗效。方法回顾性分析2013年1月至2018年12月接受术前减黄的66例老年Ⅲ~Ⅳ型肝门部胆管癌患者临床资料,根据术前选取不同减黄术式分组:PTCD组、ERBD组、ENBD组,三组患者均行肝门部胆管癌根治术。采用SPSS 20.0统计学软件进行分析,肝功能指标、围手术期指标采用(x^-±s)表示,三组间采用方差分析;并发症等计数资料行χ^2检验,P<0.05为差异有统计学意义。结果三组患者减黄后三组TBIL、AST、ALT、ALP、GGT较减黄前均明显降低(P<0.05)。减黄期三组并发症总发生率和术后围手术期指标比较差异均无统计学意义(P>0.05),但只有PTCD组未发生肝十二指肠韧带水肿。结论对于老年Ⅲ~Ⅳ型肝门部胆管癌患者术前行PTCD减黄效果最好。Objective To compare the clinical outcome of Endoscopic Nasobiliary Drainage(ENBD),Endoscopic Retrograde Biliary Drainage(ERBD)and Percutaneous Transhepatic Cholangial Drainage(PTCD)in the preoperative treatment of elderly patients with typeⅢ~Ⅳhilar cholangiocarcinoma.Methods Clinical data of 66 elderly patients with typeⅢ~Ⅳhilar cholangiocarcinoma,who received preoperative biliary drainage from January 2013 to December 2018,were analyzed retrospectively.According to the different kinds of biliary drainage,patients were divided into PTCD group,ERBD group and ENBD group.All of 66 patients underwent radical resection of hilar cholangiocarcinoma.Statistical analysis were performed by using SPSS 20.0 software.Measurement data such as liver function indexs and perioperative indexs were expressed as mean±standard deviation and were examined by variance analysis.The incidence of complications were examined by chi square test.A P value of<0.05 was considered as statistically significant.Results TBIL,AST,alt,ALP and GGT were significantly decreased in all of three groups after biliary drainage(P<0.05).There was no significant difference in terms of total incidence of complications and perioperative indexes among three groups(P>0.05),however only in PTCD group,there was no hepatoduodenal ligament edema.Conclusion Preoperative PTCD is the best way to reduce jaundice in the elderly patients with typeⅢ~Ⅳhilar cholangiocarcinoma.

关 键 词：胆管肿瘤 黄疸 疗效比较研究 PTCD ERBD ENBD 

分 类 号：R[医药卫生]