腹腔热灌注治疗对恶性梗阻性黄疸术后减黄作用的临床研究

发布时间：2018-06-27 00:07

本文选题：腹腔热灌注治疗 + 恶性梗阻性黄疸　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景恶性梗阻性黄疸是由于恶性肿瘤引起的直接或者间接胆道梗阻扩张并以高胆红素血症、组织和体液黄染为主要临床表现的疾病,如胰腺癌、胆管癌、十二指肠乳头癌以及其它恶性肿瘤转移和复发压迫胆管等。其常引起免疫系统功能损伤、呼吸功能减弱、肾脏功能衰竭等严重反应,极大增加了恶性肿瘤患者的死亡率。腹腔热灌注治疗是近年兴起的治疗腹腔恶性肿瘤的有效方法。探讨腹腔热灌注治疗在恶性梗阻性黄疸疾病中的减黄作用,既可以有效治疗恶性肿瘤,又可以减少恶性梗阻性黄疸引起的并发症,从而在提高患者生活质量以达到延长生存期的治疗目的中发挥重要作用。目的探讨腹腔热灌注治疗(Hyperthermic Intraperitoneal Chemotherapy,HIPEC)对恶性梗阻性黄疸的临床减黄作用,为HIPEC治疗恶性肿瘤提供新途径。方法选取2015年7月至2016年10月于新乡医学院第一附属医院普外科治疗的具有完整临床资料的胆管癌、胆囊癌、胰头癌、壶腹周围癌及其他肿瘤复发或转移压迫胆管者共39例,行手术解除胆道梗阻(根治术或姑息性切除术)后,行腹腔热灌注治疗者纳入治疗组(18例,46%),未行腹腔热灌注者纳入对照组(21例,54%),对两组临床资料进行回顾性分析,检测治疗组和对照组患者术前1天、术后第1天、术后第4天、术后第7天血清总胆红素(Total Bilirubin TBIL)、直接胆红素(Direct Bilirubin DBIL)、血清碱性磷酸酶(Lkaline Phosphatase ALP)相关指标水平,采用重复测量方差分析,P0.05为差异有统计学意义。结果术前1天治疗组与对照组血清TBIL、DBIL、ALP含量无统计学差异,治疗组术后第1天、术后第4天、术后第7天血清TBIL明显低于对照组(F=12.63,P0.01)、DBIL明显低于对照组(F=26.68,P0.01)、ALP明显低于对照组(F=21.76,P0.01)。结论HIPEC对恶性梗阻性黄疸术后早期有快速减黄作用。
[Abstract]:Background malignant obstructive jaundice is a major clinical manifestation of direct or indirect biliary obstruction caused by malignant neoplasms with hyperbilirubinemia, tissue and body fluid yellow staining, such as pancreatic cancer and cholangiocarcinoma. Duodenal papillary carcinoma and other malignant tumors metastasis and recurrent compression of the bile duct. It often causes serious reactions such as impaired immune system, weakened respiratory function and renal failure, which greatly increases the mortality rate of patients with malignant tumor. Peritoneal hyperthermic therapy is an effective method for the treatment of peritoneal malignant tumors. To investigate the effect of intraperitoneal hyperthermic perfusion on malignant obstructive jaundice, which can not only effectively treat malignant tumors, but also reduce the complications caused by malignant obstructive jaundice. Therefore, it plays an important role in improving the quality of life of patients in order to prolong the survival. Objective to investigate the clinical effect of hyperthermic intraperitoneal chemotherapy (HIPEC) on malignant obstructive jaundice and to provide a new approach for the treatment of malignant tumors. Methods from July 2015 to October 2016, 39 cases of cholangiocarcinoma, gallbladder carcinoma, pancreatic head carcinoma, periampullary carcinoma and other tumors were treated by general surgery in the first affiliated Hospital of Xinxiang Medical College. After operation to relieve biliary obstruction (radical operation or palliative resection), the patients who received abdominal hyperthermic perfusion therapy were included in the treatment group (18 cases, 46%) and the control group (21 cases, 54%). The clinical data of the two groups were analyzed retrospectively. Serum total bilirubin (TBIL), direct bilirubin (DBIL) and alkaline phosphatase (ALP) were measured in the treatment group and the control group on the first day before operation, on the first day after operation, on the fourth day after operation and on the seventh day after operation. The use of repeated measurement of variance analysis of P 0.05 as the difference was statistically significant. Results there was no significant difference in serum TBILD ILP levels between the treatment group and the control group one day before operation. The serum TBIL levels in the treatment group were significantly lower than those in the control group on the 1st day, the 4th day and the 7th day after operation. The level of serum TBIL in the treatment group was significantly lower than that in the control group (FF26.68 / P0.01) and the ALP was significantly lower than that in the control group (FF21.76 / P0.01). Conclusion HIPEC can reduce jaundice in early stage after malignant obstructive jaundice.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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