经皮肝穿刺肝总管置管引流术在晚期低位胆道梗阻肿瘤患者中的应用  

Application of percutaneous transhepatic hepatic duct drainage in tumors patients with advanced low biliary obstruction

作　　者：龚杰 雷泽华[1] GONG Jie;LEI Ze-hiia(Hepatobiliary and Pancreatic Surgery,Leshan Peopley s Hospital,Leshan 614000,China)

机构地区：[1]乐山市人民医院肝胆胰外科,乐山614000

出　　处：《肝胆外科杂志》2020年第6期446-449,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨经皮肝穿刺肝总管置管引流术(PTHD)在晚期低位胆道梗阻肿瘤患者中的临床效果.方法选取2019年1月-2020年1月本院收治的102例晚期低位胆道梗阻肿瘤患者,采用随机数值表法分为观察组和对照组各51例.对照组采取经皮肝穿刺胆道引流术(Percutaneous transhepatic biliary drainage,PTCD)治疗,观察组采取PTHD治疗.记录两组手术情况及术后患者舒适程度情况,检测患者术前及术后3d时的血清总胆红素(TBIL)、碱性磷酸酶(ALP)、丙氨酸转氨酶(ALT)水平,观察两组术后7d内并发症发生情况.结果两组患者的手术时间、术中出血量差异无统计学意义(P>0.05),但观察组患者的引流量明显高于对照组(P<0.05),且观察组术后3d的TBIL、ALP及ALT指标含量明显低于对照组(P<0.05).术后,观察组患者在腹痛腹胀、恶心呕吐、食欲不佳及引流管牵制方面的舒适度量表评分均明显低于对照组(P<0.05).结论与传统PTCD相比,PTHD的胆汁引流效果更优,能加速降低晚期低位胆道梗阻肿瘤患者黄疸的消退,患者术后舒适度更高,且未增加术后并发症发生风险.Objective To explore clinical effects of percutaneous transhepatic hepatic duct drainage(PTHD) in tumors patients with advanced low biliary obstruction. Methods A total of 102 tumors patients with advanced low biliary obstruction who were admitted to the hospital from January 2019 to January 2020 were enrolled. They were divided into observation group and control group by random number table method, 51 cases in each group. The control group was treated with percutaneous transhepatic cholangial drainage(PTCD), while observation group was treated with PTHD. The surgical situations and postoperative comfort in both groups were recorded. The levels of serum total bilirubin(TBIL), alkaline phosphatase(ALP) and alanine aminotransferase(ALT) before surgery and at 3 d after surgery were detected. The occurrence of complications within 7 d after surgery in both groups was observed. Results There was no significant difference in operation time or intraoperative blood loss between the two groups(P>0.05). The drainage volume in observation group was significantly more than that in control group(P<0.05). At 3 d after surgery, contents of TBIL, ALP and ALT in observation group were significantly lower than those in control group(P<0.05). After surgery, scores of comfort scale in terms of abdominal pain and distension, nausea and vomiting, poor appetite and drainage tube restraint in observation group were significantly lower than those in control group(P<0.05). Conclusion Compared with traditional PTCD, bile drainage effect of PTHD is better, which can accelerate jaundice reduction in tumors patients with advanced low biliary obstruction, improve postoperative comfort, without increasing occurrence risk of postoperative complications.

关 键 词：经皮肝穿刺肝总管置管引流术 经皮肝穿刺胆道引流术 低位胆道梗阻 黄疸 

分 类 号：R735.8[医药卫生—肿瘤]