终末期肝泡型包虫病合并梗阻性黄疸的诊治分析

发布时间：2018-08-21 08:03

【摘要】：目的：探讨治疗合并梗阻性黄疸的终末期肝泡型包虫病的方法及疗效。方法：回顾性分析从2000年1月至2013年1月在新疆医科大学一附院诊治的55例终末期肝泡型包虫病合并梗阻性黄疸患者的临床资料。根据患者的不同治疗方案进行分组,A组：姑息性手术组(姑息性病灶切除加胆道减压术组)38例(69.1%)和B组：介入组(经皮经肝胆道引流术组,即PTCD组)17例(30.9%)。比较两组的一般资料、术前、术后3-7d的肝功能指标、手术时间、出血量、平均住院天数、术后带脓腔引流管时间、病灶继续浸润和(或)转移、胆道并发症(术后胆汁瘘、胆管炎、再次并发梗阻性黄疸)、死亡率、累积生存率、生存曲线等指标。计量资料采用t或t检验,计数资料采用,检验,生存分析采用Kaplan-Meier法计算生存率,并行Log Rank检验。结果：A组的手术时间、出血量、平均住院天数明显高于B组(P0.05),而术后总胆红素、直接胆红素、r-谷氨酰转肽酶、碱性磷酸酶下降水平没有B组明显(P0.05),而且A组的术后门冬氨酸氨基转移酶、丙氨酸氨基转移酶、白蛋白受损伤水平较B组严重(P0.05)。A、B两组的一般资料(性别、年龄、民族)、术前肝功能指标、术后带脓腔引流管时间、病灶继续浸润和(或)转移、胆道并发症、死亡率、累积生存率、生存曲线相比差异无统计学意义(P0.05)。结论：介入治疗是终末期肝泡型包虫病合并梗阻性黄疸患者的一种有效治疗方法,具有微创、简便、安全、可重复性等优点,可以代替传统的姑息性手术治疗。同时,可以对此类患者的肝移植治疗争取时间,甚至为根治性切除创造机会。
[Abstract]:Objective: to investigate the treatment method and curative effect of end-stage hepatic alveolar hydatid disease with obstructive jaundice. Methods: the clinical data of 55 patients with end-stage hepatic alveolar hydatidosis complicated with obstructive jaundice were retrospectively analyzed from January 2000 to January 2013 in the first affiliated Hospital of Xinjiang Medical University. The patients were divided into two groups: group A (n = 38): palliative resection group (n = 38) and group B (n = 17): percutaneous transhepatic biliary drainage group (n = 17) (30.9%). The general data of the two groups were compared. The indexes of liver function, the time of operation, the amount of blood loss, the average days of hospitalization, the time of drainage with pus cavity after operation, the continuous infiltration and / or metastasis of the lesions, the complications of biliary tract (postoperative biliary fistula) were compared between the two groups before and after operation. Cholangitis, secondary obstructive jaundice), mortality, cumulative survival rate, survival curve and other indicators. T or t test was used for measurement data, Kaplan-Meier method was used to calculate survival rate and Log Rank test was used for counting data and survival analysis. Results the operative time, blood loss and average hospital stay in group A were significantly higher than those in group B (P0.05), while the total bilirubin, direct bilirubin and r-glutamyl transpeptidase (GTP) in group A were significantly higher than those in group B (P0.05). The decreased level of alkaline phosphatase was not significant in group B (P0.05), and the levels of aspartate aminotransferase, alanine aminotransferase and albumin in group A were more serious than those in group B (P0.05). There was no significant difference in preoperative liver function, postoperative drainage time with pus cavity, continuous infiltration and / or metastasis, biliary complications, mortality, cumulative survival rate and survival curve (P0.05). Conclusion: interventional therapy is an effective method for patients with end-stage hepatic alveolar hydatidosis complicated with obstructive jaundice. It has the advantages of minimally invasive, simple, safe and repeatable, and can replace the traditional palliative operation. At the same time, it can buy time and even create opportunities for radical resection of liver transplantation in such patients.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R532.32

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