经肝穿刺与经十二指肠镜途径胆道支架置入治疗恶性胆道梗阻性黄疸的对照研究

目的:对照经肝穿刺途径与经十二指肠镜途径胆道支架置入治疗恶性胆道梗阻性黄疸的临床效果.方法:收集我院2013年12月至2015年3月收治的恶性胆道梗阻性黄疸患者110例,按随机数表法分为实验组和对照组,每组各55例.两组患者入院后在术前均给予保肝、利尿以及抗感染等治疗,改善患者的一般情况,实验组患者行经皮肝穿刺胆道支架置入术;对照组患者给予经十二指肠镜胆道内支架置入术.观察并比较两组患者治疗前后总胆红素(total bilirubin,TB)、直接胆红素(directbilirubin,DB)、间接胆红素(indirect bilirubin,IB)水平以及治疗后平均生存期、并发症发生率、治疗总有效率水平.结果:与治疗前相比,治疗后两组患者的总胆红素、直接胆红素、间接胆红素水平均下降,差异具有统计学意义(P<0.05);与对照组相比,实验组患者的总胆红素、直接胆红素、间接胆红素水平较低,差异具有统计学意义(P<0.05);与对照组相比,实验组患者的术后平均生存期较长,差异具有统计学意义(P<0.05);与对照组相比,实验组患者并发症发生率较低,临床治疗有效率较高,差异具有统计学意义(P<0.05).结论:恶性胆道梗阻性黄疸患者应用经皮肝穿刺途径的临床效果显著优于经十二指肠镜途径胆道支架置放术,更有利于患者胆红素水平的降低,延长患者的生存期,提高了治疗效果.

Controlled Research of the Treatment of the Malignant Biliary Obstruction Jaundice by Percutaneous Transhepatic Route and the Duodenoscopic Approach Biliary Stent Placement

Objective:To investigate the clinical efficacy of the treatment of malignant biliary obstruction jaundice by percutaneous transhepatic route and duodenoscopic approach biliary stent placement. Methods:110 patients with malignant biliary obstructive jaundice from December 2013 to March 2015 accepted in our hospital,were divided into experimental group and control group by the random number table method,55 ca-ses in each group. After admission to hospital,patients in the two groups before operation were given hepato-protective,diuretic and anti infection etc.,improve the patient's general condition. Patients in the experimen-tal group were treated by percutaneous transhepatic biliary stent implantation,and the control group were trea-ted by endoscopic biliary stent implantation. The levels of total bilirubin ( TB),direct bilirubin ( DB), indi-rect bilirubin ( IB ), the average survival period, complication rate and total efficiency of the treatment be-tween the two groups before and after treatment were observed and compared. after treatment. Results: After treatment,compared with before treatment,the TB,DB and IB levels were decreased,the difference was sta-tistically significant ( P < 0.05);Compared with the control group,TB,DB,IB levels were lower in patients of the experimental group than that in control group, the difference was statistical significance ( P < 0.05);Compared with the control group, postoperative average survival period was longer in patients of the experi-mental group than that in control group,the difference was statistical significance ( P <0.05);Compared with the control group,the incidence of complications in patients of the experimental group were lower,clinical ef-fective rate was higher,and the difference was statistically significant ( P < 0.05) . Conclusion: The clinical efficacy of the percutaneous transhepatic route in the treatment of malignant biliary obstruction is better than duodenoscopic approach biliary stent placement, more conducive to reduced levels of bilirubin, prolong the survival of patients,improve the treatment efficacy.