摘要
目的探讨改良式经皮肝穿刺胆道内外引流术（PTBIED）的可行性及临床效果。方法3年之间连续就诊的，经影像检查（部分经病理检查）证实为恶性梗阻性黄疸的患者纳入研究。其中，胆道梗阻部位在肝门部至胆总管近段，残留的胆总管长度〉3cm，血清总胆红素（TBIL）≥70μmol／L的患者，纳入试验组，行改良式PTBIED；符合前述条件但不愿行改良式PTBIED的患者和低位恶性胆道梗阻的患者纳入对照组，按常规行传统式FFBIED。试验组患者根据术中造影，对胆道外引流管增加侧孔改造，将改造后的引流管头端置入残留的肝总管或胆总管，同时将增加的侧孔置于梗阻近侧扩张的胆管内。记录手术前后患者的临床症状、肝功能、血常规及并发症情况。术后随访至患者死亡。本研究中，2组患者计量资料的比较采用t检验，计数资料比较采用Х^2检验，生存时间的比较采用生存分析。结果46例患者被纳入本研究。其中21例行改良式PTBIED，25例行传统PTBIED，2组患者均手术成功，无手术相关死亡。2组患者在皮肤瘙痒、纳差、腹胀、腹痛等临床症状改善方面相似，术后胆汁日平均引流量[试验组（521±136）ml／d，对照组（606±159）ml／d（t=1．930，P〉0．05）]、血清TBIL下降水平[试验组（87±51）μmol／L，对照组（105±66）μmol／L（t=1．061，P〉0．05）]、中位生存期[试验组7．7个月，对照组6．9个月（Х^2=0．610，P〉0．05）]比较差异均无统计学意义。术后对照组白细胞计数为（10．9±5．2）×10^9／L，较术前的（7．8±2．9）×10^9/L明显增高，差异有统计学意义（t=3．606，P〈0．05）；试验组术前为（8．2±3．4）×10^9／L，较术后的（7．4±2．6）×10^9/L明显降低（t=2．649，P〈0．05）。术后试验组患者未出现十二指肠液反流现象，1例发生胆道感染；对照组11例患者发生十二指肠液反流，其中8例发生胆道感染。术后胆道感染发生率对照组明显高于试验组（Х^2=5．381，P〈0．05）。结论改良式PTBIED方便、可行，相对传统PTBIED，可减少胆道感染并发症发生率。
Objective To investigate feasibility and clinical application value of improved percutaneous transhepatie biliary internal-external drainage （PTBIED）. Methods Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible. The patients with proximal malignant biliary obstruction and intact inferior common bile duets 〉 3 cm in length, and a bilirubin of 70 ~mol/L or higher, were included in the experimental group. The control group included patients with low malignant biliary obstruction, and those who met the criteria for the experimental group but refused to receive the altered method of PTBIED. The patients underwent traditional PTBIED in control group. The patients in the experimental group received the procedure as following： according to percutaneous transhepatic cholangiography, a biliary external drainage catheter was modified by adding side-holes. Then under fluoroscopic guidance, the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duet, while the additional side-holes were located in the expanded hepatic duct. Technical success rate,complications, hepatic function and white cell count （WBC） were recorded pre- and post-procedure. All patients were followed-up until death. A t-test was used to compare continuous variable data changes, the Chi-square test was used to compare categorical variable data in two groups, and survival time was assessed using the Kaplan-Meier method. Results Forty-six patients were included in the study, with 21 in the experimental group and 25 in the control group. The procedures were successfully performed in all patients in the two groups. There was no procedure-related death in the two groups. Symptoms were improved similarly after procedures in the two groups. The mean quantity of drained bile per day [ experimental group （521 ± 136） ml/d ,control group （606 ± 159） ml/d, t = 1. 930,P 〉 0. 05 ] ,decrease of the serum total bilirubin after the procedures [ experimental group （ 87± 1 ） μmol/L, control group （ 105 ± 66 ） μmol/L （ t = 1. 061, P 〉 0. 05） ] and the median survival time （ experimental group 7. 7 months, control group 6. 9 months, Х^2 = 0. 610, P 〉 0. 05 ） of the patients showed no statistically significant difference between two groups. The mean WBC amount of patients was higher after the traditional procedure [ （ 10. 9 ±5.2） ×10^9/L] than before the procedure [ （7.8 ± 2. 9） ×10^9/L 1 in the control group （ t = 3. 606, P 〈 0. 05 ）, but the converse change occurred in the experimental group [ pre-procedure （ 8.2 ± 3.4 ） ×10^9/L ], post-procedure [ （7.4 ± 2.6 ） ×10^9/L] （ t = 2. 649, P 〈 0. 05）. No reflux of duodenal juice was observed in all patients of the experimental group, and 1 patient had infection of biliary tract. The reflux was observed in 11 patients of the control group after conventional PTBIED. Of them, 8 patients had infection of biliary tract. Incidence rate of infection of biliary tract in the control group was higher than that in the experimental group（ Х^2 = 5. 381, P 〈 0. 05 ）. Conclusions Improved PTBIED is convenient and feasible, and compared with traditional PTBIED, it can reduce the complications of infection of biliary tract.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2011年第11期1049-1053,共5页
Chinese Journal of Radiology
关键词
胆汁淤积
肝外
胆道外科手术
引流术
经皮肝穿
Cholestasis, extrahepatic
Biliary tract surgical procedures
Drainage
Percutaneous transhepatic
