重度恶性梗阻性黄疸术前超声引导经皮肝穿刺胆管引流术的应用

目的 研究重度恶性梗阻性黄疸术前经皮肝穿刺胆管引流术(PTCD)的应用价值。方法 接受根治性胰十二指肠切除术的41例重度恶性梗阻性黄疸病人(血清总胆红素>350umol/L)进行回顾分析。按术前是否行PTCD将患者分为两组。A组21例,术前在超声引导下行PTCD,引流2～3周,待血清总胆红素降至100umol/L左右即行根治性胰十二指肠切除术。B组20例,术前未行PTCD而直接行根治性胰十二指肠切除术。对比研究两组病人术后的临床结果。结果 术后1、3、7、14天APACHE Ⅱ评分系统的 APS分值,A组明显低于B组(P<0.01)。A组术后发生并发症 12例次,B组 33例次(P<0.01)。A组无手术死亡,B组死亡4例(P<0.01)。结论 对于重度恶性梗阻黄疸行根治性胰十二指肠切除术的病人,术前PTCD能明显减少术后应激反应的程度和期限,降低并发症发生和手术死亡率,提高手术疗效。

The clinical application of the ultrasound guided percutaneous transhepatic cholangio drainage in patients with severe malignant obstructive jaundice during preoperation

Obejctive To study the clinical applied value of the ultrasound guided percutaneous tran-sheptic cholangio drainage (PTCD) in patients with severe malignant obstructive jaundice during preopera-tion. Methods From March 1988 to June 2002, 41 patients with malignant obstructive jaundice were analyzed retrospectively. According to whether the PTCD was used or not, the paticnts were (divided into 2 groups: Group A) 21 cases of PTCD were performed for 2 to 3 weeks before pancreatieoduodenectomv (PD) . Group 3, 20 cases of PTCD were not used before PD. The postoperative clinical results were compared between the two groups. Results In the postoperative complication and operative mortality, the group A was obviously lower than the Group B (P < 0. 01). For the treatment of the patients with severe malignant obstructive jaundice, the preoperative PTCD can reduce the degree and time limit of postoperative stress reaction, decline postoperative complication incidence and operative mortality, and improve the efficacy of the operation.