超声引导下PTCD治疗恶性梗阻性黄疸患者的疗效及对血清炎症因子的影响  

Effectiveness of ultrasound-guided percutaneous transhepatic cholangiographic drainage for treating malignant obstructive jaundice and its influence on serum inflammatory markers

作　　者：杨正芳[1] 漆家高 白钰 何小飞 YANG Zheng-fang;QI Jia-gao;BAI Yu;HE Xiao-fei(Department of Ultrasound Medicine,Zitong County People’s Hospital,Sichuan 622150,China)

机构地区：[1]梓潼县人民医院超声医学科,四川622150

出　　处：《肝脏》2025年第1期117-121,共5页Chinese Hepatology

基　　金：四川省卫生健康委员会医学科技项目(21PJ145)。

摘　　要：目的探讨超声引导下经皮肝胆管穿刺引流术(PTCD)在恶性梗阻性黄疸中的应用效果。方法研究样本为2020年1月—2024年1月梓潼县人民医院收治的恶性梗阻性黄疸患者,共96例,随机分为对照组和观察组,各48例。接受内镜逆行胰胆管造影(ERCP)支架置入术的患者设为ERCP组,行超声引导下PTCD的患者为PTCD组。记录患者围术期指标以及低位梗阻、高位梗阻的治疗有效率,比较两组患者术前和术后1周的炎症水平和肝功能,并记录患者并发症发生情况。结果PTCD组的手术时间、术中出血量、术后下床时间和住院时间分别为(79.8±7.6)min、(80.7±8.3)mL、(4.4±0.9)d、(14.8±2.5)d,均比ERCP组增加[(70.2±7.3)min、(72.4±7.5)mL、(3.5±0.6)d、(10.2±2.1)d,P<0.05]。PTCD组中,高位梗阻的治疗有效率为95.2%,高于ERCP组(56.5%,P<0.05),两组总治疗有效率分别为79.2%和75.0%,差异无统计学意义(P>0.05)。PTCD组术后炎性因子水平高于ERCP组,肝功能指标更低,且PTCD组和ERCP组的并发症发生率分别为8.3%和27.1%,PTCD组低于ERCP组(P<0.05)。结论超声引导下PTCD的手术时间和术后恢复时间更长,但有助于改善恶性梗阻性黄疸患者的肝功能,并降低并发症的发生。Objective To evaluate the effectiveness of ultrasound-guided percutaneous transhepatic cholangiographic drainage(PTCD)in patients with malignant obstructive jaundice.Methods Our research involved 96 patients diagnosed with malignant obstructive jaundice who were treated at our hospital from January 2020 to January 2024.They were divided into two groups of 48 participants each.One group received ERCP accompanied by stent insertion,and the other underwent ultrasound-guided PTCD.Perioperative indicators,treatment efficacy for low and high blockages,and pre-and post-operative levels of inflammatory markers and liver function markers were recorded and compared.Complications such as biliary infection,acute pancreatitis,bile leakage,and bleeding comparisons were also made between the groups.Results The PTCD group exhibited prolonged surgery duration,increased intraoperative blood loss,longer time to ambulation,and lengthier hospital stay,with values of(79.8±7.6)min,(80.7±8.3)mL,(4.4±0.9)d,and(14.8±2.5)d,respectively,compared to the ERCP group[(70.2±7.3)min,(72.4±7.5)mL,(3.5±0.6)d,(10.2±2.1)d](P<0.05).In the PTCD group,the effectiveness rate for treating high-level obstructions reached 95.2%,which was higher than that in the ERCP group(56.5%)(P<0.05).The overall treatment effectiveness rates were 79.2%for the PTCD group and 75.0%for the ERCP group(P>0.05).Postoperatively,the PTCD group showed higher levels of inflammatory markers and lower liver function indicators than the ERCP group.The incidence of complications was also lower in the PTCD group(8.3%)compared to the ERCP group(27.1%)(P<0.05).Conclusion Ultrasound-guided PTCD requires longer surgery and recovery times;however,it’s beneficial in improving liver function and reducing complications in patients with malignant obstructive jaundice.

关 键 词：超声引导下经皮肝胆管穿刺引流术 内镜逆行胰胆管造影 恶性梗阻性黄疸 炎性因子 

分 类 号：R735[医药卫生—肿瘤]