PTCD应用自制胆汁回输器行胆汁回输、肠内营养支持的临床价值  

Clinical value of PTCD with homemade bile reinfusion and enteral nutrition support

作　　者：席江伟[1] 王艳[2] 刘斌[1] 王梦钦 王新波[1] 孙太冉[1] XI Jiangwei;WANG Yan;LIU Bin;WANG Mengqin;WANG Xinbo;SUN Tairan(General Surgery Department,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Infectious Diseases,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China)

机构地区：[1]河北北方学院附属第二医院普外科,河北张家口075100 [2]河北北方学院附属第二医院感染疾病科,河北张家口075100

出　　处：《安徽医药》2025年第4期743-747,I0002,共6页Anhui Medical and Pharmaceutical Journal

基　　金：张家口市科技研发计划项目(2121093D)。

摘　　要：目的探究晚期恶性梗阻性黄疸病人经皮经肝胆管穿刺引流(percutaneous transhepatic cholangial drainage,PTCD)应用自制胆汁回输器、双腔空肠营养管行胆汁回输、肠内营养支持的临床价值。方法回顾性选取2019年1月至2022年1月河北北方学院附属第二医院收治的晚期恶性梗阻性黄疸病人,按照引流方式的不同分为A组(n=25,PTCD与空肠营养管体外对接),B组(n=25,PTCD与自制胆汁回输器行胆汁回输与空肠营养液同时或间断进入空肠),C组(n=25,PTCD自体胆汁间断定时回输联合肠内营养);同时选取对照组(n=25,PTCD引流出体外胆汁丢弃;四组均同时给予肠内营养支持进行治疗。采用干式全自动生化分析仪检测谷草转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBiL)和直接胆红素(DBiL)的水平;采用西门子全自动生化分析仪检测白蛋白、前白蛋白(PA)的水平;使用微型营养评估(MNA)量表对所有病人进行评分。结果A、B、C组和对照组的AST[(104.72±8.13)U/L、(97.61±7.96)U/L、(106.56±8.25)U/L、(114.52±8.47)U/L]、ALP[(331.46±17.67)U/L、(317.15±16.83)U/L、(333.54±18.01)U/L、(342.96±18.74)U/L]、TBiL、DBiL水平在治疗后与治疗前比较均显著降低[(132.18±11.24)U/L、(131.53±10.87)U/L、(130.73±10.62)U/L、(129.46±10.15)U/L;(403.37±25.51)U/L、(401.76±25.35)U/L、(398.72±24.87)U/L、(395.94±24.63)U/L](P<0.05);治疗后A、B、C组的AST、ALP、TBiL、DBiL水平均显著低于对照组且B组显著低于A、C组(P<0.05);A、B、C组和对照组的白蛋白、PA水平在治疗后均显著升高(P<0.05);治疗后A、B、C组的白蛋白、PA水平均显著高于对照组且B组显著高于A、C组(P<0.05);A、B、C组和对照组的MNA评分在治疗后均显著升高(P<0.05);治疗后A、B、C组的MNA评分均显著高于对照组且B组显著高于A、C组(P<0.05)。结论PTCD后使用自制胆汁回输器将引流收集的胆汁与空肠营养液同时或间断输入空肠治疗更有助于晚期恶�Objective To explore the clinical value of self-made bile reinfusion device and double-lumen jejunal nutrition tube for bile reinfusion and enteral nutrition support in the percutaneous transhepatic cholangial drainage(PTCD)for patients with advanced malignant obstructive jaundice.Methods Patients with advanced malignant obstructive jaundice admitted to The Second Affiliated Hospital of Hebei North University from January 2019 to January 2022 were retrospectively selected and divided into group A(n=25):PTCD and jejunal nutrition tube in vitro docking,group B(n=25):PTCD and homemade bile reinfusion into the jejunum at the same time or intermittently,group C(n=25):PTCD intermittent autologous bile infusion combined with enteral nutrition;At the same time,the control group(n=25)was selected to discard the bile:PTCD drained out of the body,and enteral nutrition support was given for treatment.The levels of aspartate aminotransferase(AST),alkaline phosphatase(ALP),total bilirubin(TBiL)and direct bilirubin(DBiL)were detected by dry automatic biochemical analyzer.Siemens automatic biochemical analyzer was used to detect the levels of albumin(ALB)and prealbumin(PA).All patients were scored using a mini-nutrient assessment scale(MNA).Results In groups A,B,C and control group,AST[(104.72±8.13)U/L,(97.61±7.96)U/L,(106.56±8.25)U/L,(114.52±8.47)U/L],ALP[(331.46±17.67)U/L,(317.15±16.83)U/L,(333.54±18.01)U/L,(342.96±18.74)U/L],TBiL,DBiL levels were significantly reduced after treatment compared with pre-treatment[(132.18±11.24)U/L,(131.53±10.87)U/L,(130.73±10.62)U/L,(129.46±10.15)U/L;(403.37±25.51)U/L,(401.76±25.35)U/L,(398.72±24.87)U/L,(395.94±24.63)U/L](P<0.05);AST,ALP,TBiL and DBiL levels in groups A,B and C were significantly lower than those in the control group and group B was significantly lower than groups A and C after treatment(P<0.05);albumin and PA levels in groups A,B,C and the control group were significantly higher after treatment(P<0.05).The levels of albumin and PA in groups A,B and C were signi

关 键 词：黄疸 阻塞性 肠道营养 经皮经肝胆管穿刺引流 胆汁回输器 双腔空肠营养管 胆汁回输 

分 类 号：R73[医药卫生—肿瘤]