改良式多侧孔鼻胆管内引流与经皮经肝胆管引流术在晚期胆管癌治疗中的对比研究  

A comparative study of modified multi-side hole nasobiliary drainage and percutaneous transhepatic cholangial drainage in the treatment of advanced cholangiocarcinoma

作　　者：周华波[1] 何伊嘉 李广阔 孙科[1] 杨帅 里越 黎欢 ZHOU Huabo;HE Yijia;LI Guangkuo;SUN Ke;YANG Shuai;LI Yue;LI Huan(Department of Hepatobiliary Surgery,Chengdu Second People’s Hospital,Chengdu 610017,China)

机构地区：[1]成都市第二人民医院肝胆外科,四川成都610017

出　　处：《实用放射学杂志》2025年第3期478-481,共4页Journal of Practical Radiology

摘　　要：目的 比较经皮经肝胆管造影术(PTC)通路施行改良式多侧孔鼻胆管内引流(MHND)与传统经皮经肝胆管引流术(PTCD)姑息性治疗晚期梗阻性胆管癌患者的临床疗效.方法 回顾性分析行胆管引流的66例晚期胆管癌患者资料.结果 2组患者均在穿刺后24 h内恢复正常体温,急性胆管炎症状得以缓解.术后48 h白细胞(WBC)、总胆红素(TBiL)、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)等实验室指标及术后住院期间胆漏、胆汁性腹膜炎、胆管炎的发生率差异无统计学意义(P>0.05).但PTCD组在术后电解质紊乱、消化道症状发生率及随访期间的消化道症状复发率上明显高于 MHND组,而 MHND组在随访期间的胆道感染复发率稍高于PTCD组.2组比较差异有统计学意义(P<0.05).结论 改良式 MHND在晚期肿瘤黄疸患者治疗中有较好的临床疗效.与传统PTCD方式比较,它在有效退黄、缓解急性胆管炎的同时,还大幅度减少了后期患者带管过程中的消化道症状,提高了患者的生活质量.但值得注意的是,它同时也会增加患者的胆道感染风险.Objective To compare the clinical efficacy of modified multi-side hole nasobiliary drainage(MHND)via the percutaneous transhepatic cholangiography(PTC)route with traditional percutaneous transhepatic cholangial drainage(PTCD)for palliative treatment of patients with advanced obstructive cholangiocarcinoma.Methods A retrospective analysis was conducted on the data from 66 patients with advanced cholangiocarcinoma who underwent biliary drainage.Results Both groups normalize temperature and alleviate symptoms of acute cholangitis within 24 h post-puncture.There was no statistically significant difference in laboratory indicators such as white blood cell(WBC),total bilirubin(TBiL),alanine transaminase(ALT),aspartic transaminase(AST)at 48 h post-operation,and in the incidence of bile leakage,biliary peritonitis,and cholangitis during the postoperative hospital stay(P>0.05).However,the incidence of postoperative electrolyte disorders,gastrointestinal symptoms,and the recurrence rate of gastrointestinal symptoms during the follow-up period were significantly higher in the PTCD group compared to the MHND group,while the recurrence rate of biliary tract infections was slightly higher in the MHND group compared to the PTCD group.The differences between the two groups were statistically significant(P<0.05).Conclusion Modified MHND shows better clinical efficacy in the treatment of patients with advanced tumor jaundice.Compared with traditional PTCD,it not only effectively reduces jaundice and relieves acute cholangitis but also significantly reduces gastrointestinal symptoms during the postoperative period,thereby improving the quality of life for patients.However,it is noteworthy that it may also increase the risk of biliary tract infections.

关 键 词：胆管癌 梗阻性黄疸 胆汁引流 经皮肝穿 

分 类 号：R735.8[医药卫生—肿瘤] R575[医药卫生—临床医学] R815