不同微创方式治疗恶性梗阻性黄疸的疗效分析  

Analysis of the effect of different minimally invasive methods on malignant obstructive jaundice

作　　者：张阿洁 李大鹏[1] 邓晓晶[1] 燕善军[1] 赵义[1] 郑海伦[1] ZHANG A-jie;LI Da-peng;DENG Xiao-jing;YAN Shan-jun;ZHAO Yi;ZHENG Hai-lun(Department of Gastroenterology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233000)

机构地区：[1]蚌埠医学院第一附属医院消化内科,233000

出　　处：《现代消化及介入诊疗》2021年第11期1363-1367,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：安徽省自然科学基金(1808085MH240)。

摘　　要：目的探讨四种不同微创方法治疗恶性梗阻性黄疸的疗效。方法回顾性分析2016年6月至2019年12月蚌埠医学院第一附属医院治疗的350例恶性胆道梗阻患者的临床资料,按术式分为四组:经内镜下支架引流组(A组)、单纯PTCD术组(B组)、经皮肝胆管支架植入术组(C组)、经皮肝胆管支架联合^(125)I粒子植入组(D组)。分析比较四组术前术后肝功能变化情况,高位和低位胆道梗阻的通畅时间及生存期、并发症发生率。结果与术前相比,四组术后1周的TBiL、DBiL、ALT等指标均有明显下降(P<0.05)。A组的低位胆道梗阻的通畅时间及生存期的中位数(第一四分位、第三四分位)分别为9.0(7.0,12.2)、10.5(9.0,14.0),高于高位胆道梗阻的8.0(4.0,11.0)、9.0(6.0,12.0),P均<0.05;D组的低位胆道梗阻的通畅时间及生存期的中位数(第一四分位、第三四分位)分别为12.0(7.5,14.0)、13.0(8.5,15.0),高于C组的8.0(7.0,9.0)、9.0(8.0,10.0),P均<0.05;B组的通畅时间及生存期最短,对于其他三组差异有统计学意义(P<0.05)。A组的总并发症发生率低于其他三组,差异有统计学意义(P<0.05)。结论经内镜下支架引流术在处理低位胆道梗阻时有其独特的优势,在处理高位胆道梗阻时,无论是经内镜还是经PTCD途径或联合局部放疗都是可以选择的方式。Objective To explore the efficacy of four different minimally invasive methods in the treatment of malignant obstructive jaundice.Methods Collecting patients with malignant biliary obstruction who went to the First Affiliated Hospital of Bengbu Medical College from June 2016 to December 2019.They were divided into four groups according to the operation method:endoscopic stent drainage group(group A)and simple PTCD operation Group(B group),percutaneous hepatic bile duct stent implantation group(C group),percutaneous hepatic bile duct stent combined with 125 I seed implantation group(D group).To analyze and compare the changes of liver function before and after the surgery,the patency time and survival time of high and low biliary obstruction,and the incidence of complications.Results Compared with preoperatively,the TBIL,DBIL,ALT and other indicators of the four groups at 1 week after the operation all decreased significantly,the treatment was effective,and the difference was statistically significant(P<0.05).The patency time and median survival time(first quartile,third quartile)of low biliary obstruction in group A were 9.0(7.0,12.2)and 10.5(9.0,14.0),respectively,which were higher than those of high biliary obstruction 8.0(4.0,11.0),9.0(6.0,12.0),P<0.05;The patency time and median survival time(first quartile,third quartile)of low biliary obstruction in group D were 12.0(7.5,14.0)and 13.0(8.5,15.0),respectively,which were higher than those in group C 8.0(7.0,9.0),9.0(8.0,10.0),P<0.05;Group B has the shortest patency time and survival time,and there are statistics for the differences in the other three groups Scientific significance(P<0.05).The total incidence of complications in group A was lower than the other three groups,and the difference was statistically significant(P<0.05).Conclusion Endoscopic stent drainage has its unique advantages in the treatment of low biliary obstruction.In the treatment of high biliary obstruction,either through endoscopy or through PTCD approach or combined with local radiothera

关 键 词：恶性胆道梗阻 逆行性胰胆管造影 经皮肝穿刺胆道引流术 胆道支架 

分 类 号：R575.7[医药卫生—消化系统] R576[医药卫生—内科学]