胆道支架联合PTCD对恶性梗阻性黄疸患者肝功能与生活质量的影响研究

目的研究胆道支架联合PTCD对恶性梗阻性黄疸患者肝功能与生活质量的影响。方法随机选取2006年4月至2016年4月期间在我院肝胆外科就诊的恶性梗阻性黄疸的患者216例为研究对象,均采用胆道支架联合PTCD治疗,分析患者胆管狭窄部位及原因,术前3d、术后3d、7d和14d肝功能指标:白蛋白、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素,术后并发症及随访结果,对术前感染、肝功能评分和术后针对肿瘤治疗进行多因素COX模型回归分析,采用SPSS20.0统计学软件进分析。结果 (1)肝管癌患者有87例,其中,胆总管60例,肝门部胆管12例,左右肝管15例;胰腺癌患者有35例,狭窄原因为胆总管;肝癌患者有25例,其中,胆总管11例,肝门部胆管6例,多部位8例;壶腹周围癌患者有30例,狭窄原因为胆总管;胃癌肝转移患者有39例,其中,肝门部胆管23例,多部位16例。(2)术后3d、7d和14d的白蛋白、碱性磷酸酶、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素含量水平均低于术前,术前后的比较有统计学差异(P0.05);随着术后时间的延长,白蛋白、碱性磷酸酶、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素含量水平逐渐降低,趋于正常值范围。(3)胆道感染的患者有17例,发生率为7.87%;急性胰腺炎的患者有21例,发生率为9.72%;支架脱落移位的患者有6例,发生率为2.78%;本组216例患者获访,随访时间为8d-120个月,平均每3个月随访一次,随访期间,有171例患者死亡,均死于肿瘤进展及多脏器功能衰竭,45例患者至随访截止时无黄疸加重症状。(4)术前感染、肝功能评分和术后针对肿瘤治疗是恶性梗阻性黄疸发生的独立因素(P0.05)。结论胆道支架联合PTCD是恶性梗阻性黄疸治疗的有效方法,能提高患者肝功能和改善生活质量,延长生存期。

Effect of biliary stent combined with PTCD on liver function and quality of life in patients with malignant obstructive jaundice

Objective To study the effect of biliary stent combined with PTCD on liver function and quality of life in patients with malignant obstructive jaundice.Methods 216 cases were randomly selected from April 2006 to April 2016 during the period of malignant obstructive jaundice in our hospital department of hepatobiliary surgery in our hospital patients as the research object,adopts the biliary stent combined with PTCD treatment,analysis and reasons of patients with bile duct stenosis,preoperative 3D,3D,7d and 14d of liver function index:serum albumin,alanine aminotransferase,total bilirubin and the direct and indirect bilirubin,complications and follow-up results after operation,preoperative infection,liver function score and postoperative tumor treatment for multi factor regression analysis COX model,using SPSS20.0 statistical analysis software.Results (1) Hepatic duct carcinoma in 87 patients,including 60 cases of common bile duct,12 cases of hilar bile duct,left and right hepatic duct in 15 cases;35 cases of pancreatic cancer patients,stenosis of common bile duct;25 cases of liver cancer patients,among them,11 cases of common bile duct,6 cases of hepatic hilar bile duct,8 cases of multiple sites in patients with abdominal cancer around;pot in 30 cases,common bile duct stenosis;gastric cancer patients with liver metastasis in 39 cases,including 23 cases of hilar bile duct,16 cases of multiple sites.(2) 3d,7d and 14d albumin,alkaline phosphatase,alanine aminotransferase,total bilirubin,direct bilirubin and indirect bilirubin levels were lower than the preoperative postoperative,before and after operation were statistically significant difference (P ＜ 0.05);with the postoperative time,albumin,alkaline phosphatase,alanine aminotransferase,total bilirubin,direct and indirect bilirubin levels decreased gradually and tends to normal range.(3) Biliary tract infection in 17 patients,the incidence rate was 7.87％;21 cases of patients with acute pancreatitis,the incidence rate was 9.72％;stent displacement in 6 patients,the incidence rate was 2.78％;216 patients in this group were followed up,the follow-up time was 8d-120 months,average every 3 months a follow-up,follow-up,171 patients died,died of tumor progression and multiple organ failure,45 patients at the end of the follow-up without jaundice exacerbation symptoms.(4)Preoperative infection,liver function score and postoperative tumor therapy were the independent factors for malignant obstructive jaundice (P ＜ 0.05).Conclusion Biliary stent combined with PTCD is an effective method in the treatment of malignant obstructive jaundice.It can improve the liver function and improve the quality of life and prolong the survival time of patients with malignant obstructive jaundice.