中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2011年
11期
1049-1053
,共5页
胆汁淤积,肝外%胆道外科手术%引流术%经皮肝穿
膽汁淤積,肝外%膽道外科手術%引流術%經皮肝穿
담즙어적,간외%담도외과수술%인류술%경피간천
Cholestasis,extrahepatic%Biliary tract surgical procedures%Drainage%Percutaneous transhepatic
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＞3 cm,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PTBIED.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x2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)mol/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(x2=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)×109/L,较术前的(7.8±2.9)×109/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)×109/L,较术后的(7.4±2.6)×109/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(x2 =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.
目的 探討改良式經皮肝穿刺膽道內外引流術(PTBIED)的可行性及臨床效果.方法 3年之間連續就診的,經影像檢查(部分經病理檢查)證實為噁性梗阻性黃疸的患者納入研究.其中,膽道梗阻部位在肝門部至膽總管近段,殘留的膽總管長度＞3 cm,血清總膽紅素(TBIL)≥70μmol/L的患者,納入試驗組,行改良式PTBIED；符閤前述條件但不願行改良式PTBIED的患者和低位噁性膽道梗阻的患者納入對照組,按常規行傳統式PTBIED.試驗組患者根據術中造影,對膽道外引流管增加側孔改造,將改造後的引流管頭耑置入殘留的肝總管或膽總管,同時將增加的側孔置于梗阻近側擴張的膽管內.記錄手術前後患者的臨床癥狀、肝功能、血常規及併髮癥情況.術後隨訪至患者死亡.本研究中,2組患者計量資料的比較採用t檢驗,計數資料比較採用x2檢驗,生存時間的比較採用生存分析.結果 46例患者被納入本研究.其中21例行改良式PTBIED,25例行傳統PTBIED,2組患者均手術成功,無手術相關死亡.2組患者在皮膚瘙癢、納差、腹脹、腹痛等臨床癥狀改善方麵相似,術後膽汁日平均引流量[試驗組(521±136) ml/d,對照組(606±159) ml/d(t=1.930,P＞0.05)]、血清TBIL下降水平[試驗組(87±51)mol/L,對照組(105±66) μmol/L(t=1.061,P＞0.05)]、中位生存期[試驗組7.7箇月,對照組6.9箇月(x2=0.610,P＞0.05)]比較差異均無統計學意義.術後對照組白細胞計數為(10.9±5.2)×109/L,較術前的(7.8±2.9)×109/L明顯增高,差異有統計學意義(t =3.606,P＜0.05)；試驗組術前為(8.2±3.4)×109/L,較術後的(7.4±2.6)×109/L明顯降低(t =2.649,P＜0.05).術後試驗組患者未齣現十二指腸液反流現象,1例髮生膽道感染；對照組11例患者髮生十二指腸液反流,其中8例髮生膽道感染.術後膽道感染髮生率對照組明顯高于試驗組(x2 =5.381,P＜0.05).結論 改良式PTBIED方便、可行,相對傳統PTBIED,可減少膽道感染併髮癥髮生率.
목적 탐토개량식경피간천자담도내외인류술(PTBIED)적가행성급림상효과.방법 3년지간련속취진적,경영상검사(부분경병리검사)증실위악성경조성황달적환자납입연구.기중,담도경조부위재간문부지담총관근단,잔류적담총관장도＞3 cm,혈청총담홍소(TBIL)≥70μmol/L적환자,납입시험조,행개량식PTBIED；부합전술조건단불원행개량식PTBIED적환자화저위악성담도경조적환자납입대조조,안상규행전통식PTBIED.시험조환자근거술중조영,대담도외인류관증가측공개조,장개조후적인류관두단치입잔류적간총관혹담총관,동시장증가적측공치우경조근측확장적담관내.기록수술전후환자적림상증상、간공능、혈상규급병발증정황.술후수방지환자사망.본연구중,2조환자계량자료적비교채용t검험,계수자료비교채용x2검험,생존시간적비교채용생존분석.결과 46례환자피납입본연구.기중21례행개량식PTBIED,25례행전통PTBIED,2조환자균수술성공,무수술상관사망.2조환자재피부소양、납차、복창、복통등림상증상개선방면상사,술후담즙일평균인류량[시험조(521±136) ml/d,대조조(606±159) ml/d(t=1.930,P＞0.05)]、혈청TBIL하강수평[시험조(87±51)mol/L,대조조(105±66) μmol/L(t=1.061,P＞0.05)]、중위생존기[시험조7.7개월,대조조6.9개월(x2=0.610,P＞0.05)]비교차이균무통계학의의.술후대조조백세포계수위(10.9±5.2)×109/L,교술전적(7.8±2.9)×109/L명현증고,차이유통계학의의(t =3.606,P＜0.05)；시험조술전위(8.2±3.4)×109/L,교술후적(7.4±2.6)×109/L명현강저(t =2.649,P＜0.05).술후시험조환자미출현십이지장액반류현상,1례발생담도감염；대조조11례환자발생십이지장액반류,기중8례발생담도감염.술후담도감염발생솔대조조명현고우시험조(x2 =5.381,P＜0.05).결론 개량식PTBIED방편、가행,상대전통PTBIED,가감소담도감염병발증발생솔.
Objective To investigate feasibility and clinical application value of improved percutaneous transhepatic 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 ducts ＞ 3 cm in length,and a bilirubin of 70 μmol/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 duct,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 ± 51 ) 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,x2 =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) × 109/L] than before the procedure [ (7.8 ±2.9) × 109/L] 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) × 109/L ],post-procedure [ (7.4 ± 2.6) × 109/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( x2 =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.
