PTBD和ERCP治疗泡型肝包虫病合并梗阻性黄疸的疗效对比

发布时间：2018-03-28 16:08

本文选题：泡型肝包虫病　切入点：PTBD　出处：《青海大学》2017年硕士论文

【摘要】：目的:通过对比PTBD和ERCP治疗HAE合并梗阻性黄疸患者的疗效,为临床选择一种更优的方法来缓解晚期HAE患者的黄疸情况提供参考。方法:收集青海大学附属医院2012年1月至2016年9月就诊的初步诊断为肝包虫病患者的病例资料,按纳入排除标准筛选符合条件的HAE合并梗阻性黄疸患者,分为PTBD组和ERCP组,比较两组患者的术后疗效、住院费用及预后情况。结果:1.共收集病例治疗资料1189例,其中符合纳入排除标准41例,行PTBD治疗23例,行ERCP治疗18例。两组患者的年龄、性别、民族、包虫抗体、HBV感染、病灶位置、病灶大小、梗阻部位、病灶坏死、N分期、M分期、术前手术史、术前肝功能分级等指标差别均无统计学意义(P0.05);PTBD组术前重度以上黄疸的患者较ERCP组多,ERCP组病灶钙化和处于P1、P2期的患者较PTBD组多(P0.05)。2.PTBD组和ERCP组患者术后一般状况较前好转,术后不同时期两组TBIL、DBIL、TBA、γ-GT、ALP等黄疸指标较术前均明显下降(P0.05);术后TBIL下降程度,PTBD组较ERCP组更明显(P0.05)。3.术后两组间ALT、AST、CHE、ALB、PT、APTT、PLT等其它肝功能指标差别无统计学意义(P0.05)。4.在入院时和出院时患者黄疸比较,PTBD组和ERCP组患者TBIL水平均下降,差别有统计学意义(P0.01);在入院时和出院时肝功能Child分级比较上,PTBD组差别有统计学意义(P0.05),ERCP组差别无统计学意义(P0.05)。5.术前ALB水平是影响HAE患者术前黄疸程度的保护性因素(P0.05,OR1)。6.胆囊炎、术前ALB、术前PLT是影响HAE患者术后是否发生并发症的保护性因素(P0.05,OR1),病灶M分期是影响HAE患者预后的保护性因素(P0.05,HR1)。7.PTBD组治疗费用低于ERCP组(P0.05),但两组间住院总费用差别无统计学意义(P0.05)。8.两组间在术后并发症发生率和预后生存率方面差别无统计学意义(P0.05)。结论:PTBD和ERCP均有效降低HAE患者胆红素及梗阻性黄疸相关肝功能指标水平,改善患者一般情况,但两者均未明显改善非黄疸直接相关肝功能指标。PTBD和ERCP在术后并发症发生率和预后生存率方面可能没有差异。PTBD相比于ERCP操作简单,治疗费用更低,但两者住院总费用无差别。
[Abstract]:Objective: to compare the efficacy of PTBD and ERCP in the treatment of HAE with obstructive jaundice. To provide a reference for clinical selection of a better method to alleviate jaundice in patients with advanced HAE. Methods: data of patients with hepatic hydatidosis diagnosed in the affiliated Hospital of Qinghai University from January 2012 to September 2016 were collected. According to the exclusion criteria, HAE patients with obstructive jaundice were selected and divided into two groups: PTBD group and ERCP group. The curative effect, hospitalization cost and prognosis of the two groups were compared. Among them, 41 cases were included in the exclusion criteria, 23 cases were treated with PTBD and 18 cases were treated with ERCP. The age, sex, nationality, hydatid antibody infection, location, size, site of obstruction and N stage M stage of lesion necrosis were observed in the two groups. History of preoperative surgery, There was no significant difference in preoperative liver function grading between patients with severe jaundice before operation and patients with severe jaundice before operation in ERCP group than those in PTBD group with more calcification and P1P _ 2 stage than those in PTBD group. 2. The general postoperative status of patients in PTBD group and ERCP group was better than that in PTBD group. The jaundice indexes such as TBILD DBILP TBA, 纬 -GTT ALP in two groups were significantly lower than those before operation (P 0.05), and the degree of TBIL decrease after operation in PTBD group was significantly higher than that in ERCP group (P 0.05. 3). There was no significant difference between the two groups in other liver function indexes such as ALB PTTTPLT and so on. The level of TBIL in patients with jaundice was lower than that in patients with ERCP and PTBD. The difference was statistically significant (P 0.01), and there was no significant difference in Child grade of liver function between admission and discharge. Preoperative ALB level was a protective factor affecting the degree of preoperative jaundice in HAE patients (P 0.05 OR1. 6). Preoperative ALB, preoperative PLT is a protective factor influencing the occurrence of postoperative complications in patients with HAE (P0.05 OR1). The M stage of lesion is a protective factor affecting the prognosis of HAE patients. The cost of treatment in the PLT group is lower than that in the ERCP group, but there is no difference in total hospitalization cost between the two groups. There was no significant difference between the two groups in the incidence of postoperative complications and the survival rate of prognosis. Conclusion both ERCP and ERCP can effectively reduce the level of bilirubin and liver function related to obstructive jaundice in patients with HAE. There may be no difference in the incidence of postoperative complications and survival rate between PTBD and ERCP. Compared with ERCP, the operation of PTBD is simpler and the cost of treatment is lower than that of ERCP. But there was no difference in the total cost of hospitalization between the two groups.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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