不同胆道引流方式对高位恶性胆道梗阻疗效的影响

 目的 探讨不同胆道引流方式对高位恶性胆道梗阻（malignant high biliary obstruction, MHBO）疗效的影响，为临床治疗方式的选择提供参考。方法 随访MHBO患者164例，其中行胆道完全外引流18例（A组）、胆道单支架植入并对侧外引流48例（B组）、胆道优势侧引流34例（C组）、胆道双支架植入64例（D组），观察术后近、远期疗效。结果 4组患者术前ALT、AST、TBIL、DBIL与术后第3、7、14天比较，差异均有统计学意义（均P<0.05）；4组患者术后第7天的组间比较，A、B、D三组下降程度高于C组，差异均有统计学意义（均P<0.05）；4组患者术后第14天的组间比较，D组下降程度明显高于A、B、C三组，B组高于A、C两组，A组高于C组，差异均有统计学意义（均P<0.05）。4组患者术后第21天TBIL均值与术前比较，D组下降程度明显高于A、B、C三组，B组高于A、C两组，A组高于C组，差异均有统计学意义（均P<0.05）。4组患者术后生存期比较，D组中位生存期为（355.00±22.21）天，远高于A、B、C三组，差异均有统计学意义（均P<0.05）。结论 胆道双支架植入实现了胆汁的充分内引流，对迅速消除黄疸具有明显的优越性，明显的提高了患者的生存质量及延长了生存期。

Effect of Different Biliary Drainage Methods in Treatment of Malignant High Biliary Obstruction

Objective To explore the correlation of different biliary drainage methods with curative effect in the treatment of malignant high biliary obstruction(MHBO). Methods A retrospective investigation was performed in 164 patients diagnosed as MHBO in the Fourth Hospital of Hebei Medical University. Among them, 18 cases received complete external drainage of biliary tract(group A), 48 cases received biliary single stent implantation combined with lateral drainage(group B), 34 cases received external drainage of biliary tract(group C), and 64 cases received biliary double stent implantation(group D). The short-term and long-term therapeutic evaluations as well as the postoperative complications were observed. Results The differences in ALT, AST, TBIL and DBIL of all patients before operation and the 3rd, 7th, 14th day after operation were significant (P<0.05); on the 7th day, the decreased degree in the levels of ALT, AST, TBIL and DBIL in group A, B, D were higher than those in group C (P<0.05); on the 14th day, the decreased degree in the levels of ALT, AST, TBIL and DBIL in group D were higher than those in the other three groups, while they were higher in group B compared with group A and C, higher in group A than in group C (all P<0.05); on the 21st day, the decreased degree in the level of TBIL in group D was higher than those in the other three groups, while it was higher in group B compared with group A and C, higher in group A than in group C (all P<0.05). The postoperative median survival time of group D(355.00±22.21)days] was obviously longer than the other three groups (P<0.05). Conclusion Reasonable drainage method can significantly improve the symptoms of the patients with malignant high biliary obstruction. Biliary double stent implantation can achieve adequate internal drainage, which has obvious advantages in rapid elimination of jaundice, and it is worthy of clinical promotion.