不同减黄手段在肝门部胆管癌治疗中的临床效果  

Clinical efficacy of different biliary decompression methods in the treatment of hepatic hilar cholangiocarcinoma

作　　者：杨帆[1] 段建峰[1] 赵喜荣[1] 吴林 丁建龙[1] 赵李飞 段昌虎[1] Yang Fan;Duan Jianfeng;Zhao Xirong;Wu Lin;Ding Jianlong;Zhao Lifei;Duan Changhu(Department of Hepatobiliary Surgery,Hanzhong 3201 Hospital,Xi'an Jiaotong University,Hanzhong Shaanxi 723000,China)

机构地区：[1]西安交通大学附属汉中市三二〇一医院肝胆外科,陕西汉中723000

出　　处：《保健医学研究与实践》2024年第9期56-61,共6页Health Medicine Research and Practice

基　　金：陕西省科学研发计划项目(2022SF-01413)。

摘　　要：目的比较经皮经肝胆管引流术(PTCD)、经内镜鼻胆管引流术(ENBD)治疗不同分型肝门部胆管癌(HCCA)所致黄疸的临床疗效,以期为临床治疗决策提供参考。方法选取西安交通大学附属汉中市三二〇一医院2020年1月—2021年2月收治的113例HCCA患者,按照治疗方式分为对照组(n=53)和观察组(n=60)。对照组患者接受ENBD治疗,观察组患者接受PTCD治疗。比较2组患者的引流成功率、黄疸减退情况、肝功能、并发症发生情况、复发及生存情况。结果观察组患者Ⅳ型引流成功率及总引流成功率分别为83.33%(10/12)和95.00%(57/60),高于对照组的22.22%(2/9)和75.47%(40/53),差异均有统计学意义(χ^(2)=5.546、8.830,P=0.019、0.003)。观察组患者黄疸减退率为83.33%(50/60),高于对照组的50.94%(27/53),差异有统计学意义(χ^(2)=13.599,P<0.001)。减黄手术前,2组患者血清碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、总胆汁酸(TBA)及γ-谷氨酰转肽酶(γ-GT)水平比较,差异均无统计学意义(P>0.05);手术后,2组患者血清ALP、ALT、TBA及γ-GT水平均低于手术前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。对照组和观察组患者并发症发生率分别为9.43%(5/53)和5.00%(3/60),差异无统计学意义(χ^(2)=0.302,P=0.583)。对照组和观察组患者远处转移复发率分别为26.42%(14/53)和15.00%(9/60),3年生存率分别为16.98%(9/53)和26.67%(16/60),差异均无统计学意义(χ^(2)=2.262、1.532,P=0.133、0.215)。结论与ENBD相比,PTCD在治疗Ⅳ型HCCA时具有更高的引流成功率,可有效降低γ-GT水平,改善黄疸减退情况,并有助于肝功能恢复,且安全性较高,具有较好的临床应用价值。Objective To compare the clinical efficacy of percutaneous transhepatic cholangial drainage(PTCD)and endoscopic nasobiliary drainage(ENBD)in treating jaundice caused by different types of hilar cholangiocarcinoma(HCCA),aiming to provide a reference for clinical treatment decisions.Methods A total of 113 HCCA patients admitted to Hanzhong 3201 Hospital from January 2020 to February 2021 were selected and assigned to a control group(n=53)and an observation group(n=60)according to the treatment method.Patients in the control group received ENBD treatment,while those in the observation group received PTCD treatment.The success rate of drainage,jaundice reduction,liver function,occurrence of complications,recurrence,and survival were compared between the two groups.Results The success rate of typeⅣdrainage and the overall success rate of drainage in the observation group were significantly higher than those in the control group[83.33%(10/12)vs.22.22%(2/9);95.00%(57/60)vs.75.47%(40/53);χ^(2)=5.546,8.830,P=0.019,0.003,respectively].The jaundice reduction rate in the observation group was significantly higher than that in the control group[83.33%(50/60)vs.50.94%(27/53);χ^(2)=13.599,P<0.001].Before jaundice reduction surgery,no significant differences were noted in serum alkaline phosphatase(ALP),alanine aminotransferase(ALT),total bile acid(TBA),andγ-glutamyl transpeptidase(γ-GT)levels between the two groups(P>0.05);after surgery,the levels of serum ALP,ALT,TBA,andγ-GT in both groups showed reductions,and the observation group had lower levels than the control group,with significant differences(P<0.05).The incidence of complications in the control and observation groups was 9.43%(5/53)and 5.00%(3/60),respectively,with no significant difference(χ^(2)=0.302,P=0.583).The rates of distant metastasis recurrence in the control and observation groups were 26.42%(14/53)and 15.00%(9/60),respectively,and the 3-year survival rates were 16.98%(9/53)and 26.67%(16/60),respectively,with no significant differences(χ^(2)=2.262,1

关 键 词：经皮经肝胆管引流术 经内镜鼻胆管引流术 肝门部胆管癌 黄疸 引流成功 肝功能 并发症 复发率 生存率 

分 类 号：R657.4[医药卫生—外科学]