【摘要】 目的 探讨超声引导下的经皮肝穿刺胆道引流术(PTCD)应用于BismuthⅢ、Ⅳ型胆道梗阻患者的临床疗效。方法 将95例恶性胆道梗阻患者中的BismuthⅢ型患者65例设为Ⅲ型组,BismuthⅣ型患者30例设为Ⅳ型组。比较两组患者手术时间、临床疗效及术后并发症发生情况,比较治疗前后肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBIL)和直接胆红素(DBIL)]水平及癌症患者生命质量测定量表(QLQ-C30)评分。结果 Ⅲ型组患者手术时间短于Ⅳ型组,治疗总有效率高于Ⅳ型组(P<0.05或0.01)。治疗后两组患者血清ALT、AST、GGT、ALP、TBIL和DBIL水平均较治疗前降低,且Ⅲ型组低于Ⅳ型组(P<0.05或0.01)。治疗后两组患者QLQ-C30的总体健康状况、躯体功能、角色功能、情绪功能、认知功能、社会功能、疲乏、恶心呕吐、疼痛、呼吸困难、睡眠障碍、食欲丧失、便秘维度评分均较治疗前改善,Ⅲ型组患者QLQ-C30的总体健康状况、躯体功能、情绪功能、社会功能维度评分高于Ⅳ型组,而疲乏、恶心呕吐、疼痛、呼吸困难、睡眠障碍、食欲丧失、便秘维度评分低于Ⅳ型组(P<0.05或0.01)。Ⅲ型组患者术后并发症发生率低于Ⅳ型组,但差异无统计学意义(P>0.05)。结论相较于BismuthⅣ型胆道梗阻,超声引导下的PTCD应用于BismuthⅢ型胆道梗阻患者有较好的疗效,可以改善患者肝功能和生存质量。更多还原

【Abstract】 Objective To explore the clinical effect of ultrasound-guided percutaneous transhepatic biliary drainage(PTCD) in patients with Bismuth type Ⅲ and Ⅳ malignant biliary obstruction.Methods Of 95 patients with malignant biliary obstruction 65 ones with Bismuth type Ⅲ were set as group Ⅲ and 30 ones with type Ⅳ as Ⅳ.Such indexes were compared between two groups as time of operation,clinical effects,post-operation complications as well as pre-and post-operation liver function indicators(ALT,AST,GGT,ALP,TBIL,and DBIL) and scores on the quality of life questionnaire-core 30(QLQ-C30).Results The time of operation was shorter and total effective rate higher in group Ⅲ than Ⅳ(P<0.05 or 0.01).After treatment serum ALT,AST,GGT,ALP,TBIL and DBIL levels in both groups lowered compared with pre-treatment and those were lower in group Ⅲ than Ⅳ(P<0.05 or 0.01).After treatment general health status,physical function,role function,emotional function,cognitive function,social function,fatigue,nausea and vomiting,pain,shortness of breath,insomnia,loss of appetite,and constipation of the QLQ-C30 in both groups improved compared with pre-treatment,scores on the general health status,physical function,emotional function,and social function were were higher and those on fatigue,nausea and vomiting,pain,shortness of breath,insomnia,loss of appetite,and constipation lower in Ⅲ than Ⅳ group(P<0.05 or 0.01).The incidence of postoperative complication was lower in in Ⅲ than Ⅳ group,but difference wasn’t statistically significant(P>0.05).Conclusion Ultrasound-guided PTCD has a better effect on Bismuth type Ⅲ malignant biliary obstruction and could improve liver function and quality of life compared with Bismuth type Ⅳ.更多还原