经皮肝穿刺胆管引流联合胆汁回输用于恶性梗阻性黄疸病人围手术期临床疗效分析  

Clinical efficacy of PTCD combined with bile reinfusion in patients with malignant obstructive jaundice during the perioperative period

作　　者：林志涛 成龙 张梁 苏铁 李南南 张文彬 黄金博 武林枫[1] 王刚[1] LIN Zhi-tao;CHENG Long;ZHANG Liang(Department of Pancreatic and Biliary Surgery&Department of Cerebral Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;不详)

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,黑龙江哈尔滨150001 [2]哈尔滨医科大学附属第一医院胸外科,黑龙江哈尔滨150001

出　　处：《中国实用外科杂志》2024年第7期822-828,共7页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81770639,No.82070657)。

摘　　要：目的探讨经皮肝穿刺胆管引流(PTCD)联合胆汁回输在恶性梗阻性黄疸(MOJ)病人围手术期中应用的临床疗效。方法回顾性分析2018年1月至2021年12月哈尔滨医科大学附属第一医院普外科收治的180例行胰十二指肠切除术的MOJ(总胆红素>171μmol/L)病人的临床资料。根据是否行术前PTCD减黄和胆汁回输分为回输组、未回输胆汁组和未行PTCD组,按入院时间顺序各纳入60例。比较3组病人围手术期各项临床指标,分析PTCD联合胆汁回输对MOJ病人围手术期恢复的影响。结果3组病人视黄醇结合蛋白水平、术中情况及总并发症发生率差异均无统计学意义(P>0.05)。回输组病人术后第10天的C反应蛋白水平下降幅度最大(P<0.05),前白蛋白值的升高幅度显著高于未回输组和未行PTCD组(P<0.05),血清丙氨酸氨基转移酶及总胆红素水平的下降幅度均明显大于未回输组和未行PTCD组(P<0.05)。与回输组比较,未回输组和未行PTCD组病人的术前输液量更多,术后住院时间、术后排气时间及中心静脉拔管时间更长,差异均有统计学意义(P<0.05)。回输组病人发生腹泻、电解质紊乱及胃排空延迟发生率低于未回输组和未行PTCD组,但差异均无统计学意义(腹泻:1.7%vs.11.7%vs.10.0%;电解质紊乱:3.3%vs.8.3%vs.13.3%;胃排空延迟:3.3%vs.15.0%vs.11.7%)。结论在MOJ(总胆红素>171μmol/L)病人围手术期治疗中,PTCD联合胆汁回输是一种安全、有效的辅助治疗方式,可促进病人围手术期肝脏和胃肠功能恢复,抑制炎性反应,改善营养状态,缩短术后排气及总住院时间,建议推广应用。To explore the clinical efficacy of percutaneous transhepatic cholangial drainage(PTCD)combined with bile reinfusion during the perioperative period of patients with malignant obstructive jaundice(MOJ).Methods The clinical data of 180 patients with MOJ(TBil>170μmol/L)who underwent PD at the Department of General Surgery,the First Affiliated Hospital of Harbin Medical University between January 2018 and December 2021 were retrospectively analyzed.According to whether preoperative PTCD or bile reinfusion was performed,they were divided into PTCD combined with bile reinfusion group,PTCD without bile reinfusion group,and the group without PTCD,with 60 cases in each group.Compare the clinical indicators of the three groups of patients during the perioperative period and analyze the clinical efficacy of PTCD combined with bile reinfusion in the perioperative recovery of patients with moderate and severe lower MOJ.Results There was no significant difference in the level of retinol-binding protein,the intraoperative conditions and the incidence of overall complications between patients from 3 groups(P>0.05).For patients from PTCD combined with bile reinfusion group,the largest decrease in the C-reactive protein level occurred on the 10th day after surgery(P<0.05),the increase in prealbumin was significantly higher than patients from PTCD without bile reinfusion group and the group without PTCD(P<0.05),and the decrease in alanine aminotransferase and total bilirubin was significantly larger than patients from PTCD without bile reinfusion group and the group without PTCD(P<0.05).The preoperative infusion volume,postoperative hospital stay,postoperative exhaust time and central venous extubation time in patients from PTCD without bile reinfusion group and the group without PTCD were significantly longer than patients from PTCD combined with bile reinfusion group(P<0.05).The incidences of diarrhea,ion disturbance and delayed gastric emptying in patients from PTCD combined with bile reinfusion group were lower than patients

关 键 词：经皮肝穿刺胆道引流术 胆汁回输 恶性梗阻性黄疸 胰十二指肠切除术 并发症 

分 类 号：R6[医药卫生—外科学]