三种姑息性减黄术治疗恶性胆道梗阻的疗效评价

发布时间：2018-06-25 13:00

本文选题：姑息性减黄术 + 恶性胆道梗阻　；参考：《郑州大学》2017年硕士论文

【摘要】：研究背景恶性胆道梗阻(malignant biliary obstruction,MBO)是指恶性肿瘤压迫或侵犯肝外胆管,引起胆道狭窄,从而导致胆汁排泄受阻。主要表现为黄疸、上腹痛、发热以及继发性肝功能恶化,严重者可发生脓毒血症、肝肾功能衰竭、凝血功能异常,病死率极高。若不采取及时治疗,其预后较差,平均生存期不足3个月。92%的患者半年内死亡。根治性手术切除率较低,姑息性胆道引流减黄术成为有效手段。目前临床上常用的姑息性治疗手段有外科手术、内镜下支架置入、经皮经肝胆道穿刺引流。近年来,研究不同引流方法的疗效和安全性成为研究的热点。目的通过回顾性分析我院分别行姑息性胆肠吻合术、内镜下引流术(endoscopic retrograde cholangio-pancreatography,ERCP)、经皮肝穿刺胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)不同方法的临床资料,对其临床特点及优缺点做出客观评价,为临床医生提供参考。方法2011年5月至2015年7月期间我院收治的不能行根治性手术切除的恶性胆道梗阻患者共193例,按内镜下胆道支架置入术、经皮肝穿刺胆道引流术和姑息性胆肠吻合术三种治疗方法分别分成ERCP组、PTCD组和胆肠吻合组,收集三组患者的临床资料,并对三组患者肝功能指标、术后近期并发症、住院时间和生存时间进行回顾性分析。结果1.一般资料方面,各组患者的男女比例、平均年龄、发病原因等比较均无统计学差异(P0.05),三组资料具有可比性。2.在恶性胆道梗阻的就诊首发症状中,皮肤及巩膜黄染最多见,其次为乏力、腹痛腹胀、畏寒发热等,基本与文献相符。3.在治疗效果方面,三组患者ALT、TBIL、ALP、GGT术后均出现明显下降,与术前相比差异具有统计学意义(P0.05)。各组间术后下降情况比较差异无统计学意义(P0.05)。术后通过随访比较发现,三组患者的平均生存期比较差异无统计学意义(P0.05)。4.ERCP组并发症发生率较PTCD组及胆肠吻合组明显降低,差异具有统计学意义(P0.05)。PTCD组较胆肠吻合组术后近期并发症发生率降低,比较差异有统计学意义(P0.05)。5.ERCP组和PTCD组的平均住院时间相较胆肠吻合组更短,差异具有统计学意义(P0.05)。而ERCP组和PTCD组相比较无明显差异(P0.05)。结论ERCP、PTCD、胆肠吻合术均能有效的实现胆道引流、降低黄疸、保护肝功能、延长患者生存期。都是姑息性治疗恶性胆道梗阻的有效方法。ERCP较另外两种治疗方法有一定的治疗优势,可在临床积极推广。
[Abstract]:Background malignant biliary obstruction (malignant biliary) is defined as the compression or invasion of extrahepatic bile duct by malignant tumor, which leads to biliary stricture, which leads to obstruction of bile excretion. The main manifestations were jaundice, epigastric pain, fever and secondary deterioration of liver function. In severe cases, sepsis, liver and kidney failure, abnormal coagulation function and high mortality were found. Without timely treatment, the prognosis was poor, and the average survival time was less than 3 months. 92% of the patients died within half a year. The resection rate of radical operation is low, palliative biliary drainage is an effective method. At present, the commonly used palliative treatment is surgery, endoscopic stent placement, percutaneous transhepatic biliary drainage. In recent years, research on the efficacy and safety of different drainage methods has become a hot topic. Objective to analyze the clinical data of different methods of palliative choledochostomy, endoscopic drainage (endoscopic retrograde cholangio-creatography) and percutaneous transhepatic biliary drainage (percutaneous transhepatic cholangial drainage PTCD) in our hospital, and to evaluate their clinical features, advantages and disadvantages. To provide reference for clinicians. Methods from May 2011 to July 2015, 193 patients with malignant biliary obstruction who could not be resected by radical operation were treated by endoscopic biliary stenting. Three methods of percutaneous transhepatic biliary drainage and palliative choledochojejunostomy were divided into two groups: ERCP group, PTCD group and choledochojejunostomy group. The clinical data of the three groups were collected. The hospitalization time and survival time were analyzed retrospectively. Result 1. General data, the ratio of men and women in each group, the average age, the cause of the disease were not statistically significant differences (P0.05), the three groups of comparable data. 2. Among the first symptoms of malignant biliary obstruction, yellow staining of skin and sclera was the most common, followed by fatigue, abdominal pain and abdominal distension, chilling fever, etc. In the treatment effect, the three groups of patients with alt TBILL ALP GGT decreased significantly after operation, compared with the preoperative difference was statistically significant (P0.05). There was no significant difference between the two groups (P0.05). It was found that there was no significant difference in the mean survival time among the three groups (P0.05) .4.The incidence of complications in ERCP group was significantly lower than that in PTCD group and choledochojejunostomy group. The incidence of postoperative complications in PTCD group was significantly lower than that in choledochojejunostomy group (P0.05). 5. The average hospitalization time of ERCP group and PTCD group was shorter than that of choledochojejunostomy group (P0.05). There was no significant difference between ERCP group and PTCD group (P0.05). Conclusion ERCP PTCD and cholangiojejunostomy can effectively achieve biliary drainage, reduce jaundice, protect liver function and prolong the survival time of the patients. ERCP is an effective method for palliative treatment of malignant biliary obstruction. ERCP has some advantages over the other two methods and can be popularized in clinic.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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