单纯胆道引流、胆道支架植入与部分联合~(125)I粒子条植入治疗恶性梗阻性黄疸的效果研究
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摘要
目的探讨单纯胆道引流与胆道支架植入、部分联合~(125)I粒子条植入治疗恶性梗阻性黄疸的效果。方法选取2015年1月至2017年12月收治的恶性梗阻性黄疸患者83例,对照组60例采用单纯胆道引流治疗,观察组23例采用胆道支架植入(10例)、胆道支架植入联合~(125)I粒子条植入(13例)治疗。对比2组治疗前后肝功能指标变化、并发症发生率及治疗结局。结果观察组治疗后ALT、AST、ALB、TBIL、DBIL指标均低于对照组,差异有统计学意义(P<0.05);观察组胆道感染、胆道出血、腹膜炎、引流不畅、胆心反射、胆源性胰腺炎发生率与对照组相比差异无统计学意义(P>0.05);观察组治疗有效率高于对照组,差异有统计学意义(P<0.05)。结论单纯胆道引流与胆道支架植入、部分联合~(125)I粒子条植入治疗恶性梗阻性黄疸安全性均较高,但后者对改善患者肝功能指标及治疗结局更为有效,值得推广应用。
Objective To investigate the therapeutic effects of simple biliary drainage and biliary stent implantation or combined with iodine-125 particle implantation in treatment of malignant obstructive jaundice.Methods Eighty-three patients with malignant obstructive jaundice who were admitted and treated in our hospital from January 2015 to December 2017 were divided into control group(n=60) and observation group(n=23).The patients in control group were treated by simple biliary drainage,however the 10 patients in observation group were treated by biliary stent implantation,and the other 13 patients in observation group were treated by biliary stent implantation combined with iodine 125 particle implantation.The changes of liver function indexes,incidence rate of complications and treatment outcomes before and after treatment were observed and compared between the two groups.Results After treatment,the levels of ALT,AST,ALB,TBIL and DBIL in observation group were significantly lower than those in control group(P<0.05).However there were no significant differences in the incidence rates of biliary tract infection,biliary tract bleeding,peritonitis,poor drainage and biliary reflex between the two groups(P>0.05).More over the total effective rate in observation group was significantly higher than that in control group(P<0.05).Conclusion The biliary tract drainage,biliary stent implantation and partial iodine-125 particle implantation are all safe in treatment of malignant obstructive jaundice,however,the latter is more effective in improving liver function and treatment outcomes,therefor, it is worthy of popularization and application in clinical practice.
Objective To investigate the therapeutic effects of simple biliary drainage and biliary stent implantation or combined with iodine-125 particle implantation in treatment of malignant obstructive jaundice.Methods Eighty-three patients with malignant obstructive jaundice who were admitted and treated in our hospital from January 2015 to December 2017 were divided into control group(n=60) and observation group(n=23).The patients in control group were treated by simple biliary drainage,however the 10 patients in observation group were treated by biliary stent implantation,and the other 13 patients in observation group were treated by biliary stent implantation combined with iodine 125 particle implantation.The changes of liver function indexes,incidence rate of complications and treatment outcomes before and after treatment were observed and compared between the two groups.Results After treatment,the levels of ALT,AST,ALB,TBIL and DBIL in observation group were significantly lower than those in control group(P<0.05).However there were no significant differences in the incidence rates of biliary tract infection,biliary tract bleeding,peritonitis,poor drainage and biliary reflex between the two groups(P>0.05).More over the total effective rate in observation group was significantly higher than that in control group(P<0.05).Conclusion The biliary tract drainage,biliary stent implantation and partial iodine-125 particle implantation are all safe in treatment of malignant obstructive jaundice,however,the latter is more effective in improving liver function and treatment outcomes,therefor, it is worthy of popularization and application in clinical practice.
引文
1 陆磊,金杭斌,杨建锋,等.内镜超声引导胆道会师技术治疗胆总管结石一例.中华消化内镜杂志,2018,35:66-67.
2 张诚,杨玉龙,马跃峰,等.导丝在内镜鼻胆管引流术围手术期中的应用价值.中华肝胆外科杂志,2018,24:124-125.
3 Fang D,He Y,Luan Z.Simvastatin augments activation of liver regeneration through attenuating transforming growth factor-β1 induced-apoptosis in obstructive jaundice rats.Exp Ther Med,2017,14:4839-4845.
4 王杰,刘厚宝.肝门部胆管癌术前胆道引流的现状和研究进展.中华肝胆外科杂志,2018,24:59-64.
5 贺俊景,姚家琪,周国兴,等.低位梗阻性黄疸中医辨证分型与超高场强MRCP影像改变的相关性探讨.中国中西医结合影像学杂志,2018,16:1-3,7.
6 王希春,于晓霞,付维利.经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸疗效观察.中国实用医药,2018,13:39-40.
7 Martinez JM,Anene A,Bentley TG,et al.Cost effectiveness of metal stents in relieving obstructive jaundice in patients with pancreatic cancer.J Gastrointest Cancer,2017,48:58-65.
8 蒋孙路,黄强,翟东升.经内镜逆行胰胆管造影术和经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的疗效对比.中国内镜杂志,2018,24:75-79.
9 陈安平,曾乾桃,周华波,等.腹腔镜胆总管探查一期缝合术的临床疗效(附2429例报告).中华消化外科杂志,2018,17:299-303.
10 钱震,刘会春,庞青,等.胆道支架植入联合125I粒子腔内照射治疗胰头癌临床疗效分析.现代医药卫生,2018,34:1123-1127.
11 Goutorbe F,Rouquette O,Mulliez A,et al.Temporary placement of a covered duodenal stent can avoid riskier anterograde biliary drainage when ERCP for obstructive jaundice fails due to duodenal invasion.Surg Endosc,2017,31:625-631.
12 李烽,张贵军,孙勤学,等.数字减影血管造影联合彩色多普勒超声引导经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的临床应用.现代实用医学,2018,30:22-23,27.
13 许显明.梗阻性黄疸行内镜下逆行胰胆管造影支架植入术后并发急性胆囊炎的影响因素.广西医学,2018,40:527-530.
14 董绪德,姜学远,王禹.肝囊肿致梗阻性黄疸1例报道.肝胆外科杂志,2018,26:80.
15 郑硕,黄奕红.超声引导经皮经肝胆道穿刺引流术治疗梗阻性黄疸50例分析.福建医药杂志,2018,40:78-80.
2 张诚,杨玉龙,马跃峰,等.导丝在内镜鼻胆管引流术围手术期中的应用价值.中华肝胆外科杂志,2018,24:124-125.
3 Fang D,He Y,Luan Z.Simvastatin augments activation of liver regeneration through attenuating transforming growth factor-β1 induced-apoptosis in obstructive jaundice rats.Exp Ther Med,2017,14:4839-4845.
4 王杰,刘厚宝.肝门部胆管癌术前胆道引流的现状和研究进展.中华肝胆外科杂志,2018,24:59-64.
5 贺俊景,姚家琪,周国兴,等.低位梗阻性黄疸中医辨证分型与超高场强MRCP影像改变的相关性探讨.中国中西医结合影像学杂志,2018,16:1-3,7.
6 王希春,于晓霞,付维利.经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸疗效观察.中国实用医药,2018,13:39-40.
7 Martinez JM,Anene A,Bentley TG,et al.Cost effectiveness of metal stents in relieving obstructive jaundice in patients with pancreatic cancer.J Gastrointest Cancer,2017,48:58-65.
8 蒋孙路,黄强,翟东升.经内镜逆行胰胆管造影术和经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的疗效对比.中国内镜杂志,2018,24:75-79.
9 陈安平,曾乾桃,周华波,等.腹腔镜胆总管探查一期缝合术的临床疗效(附2429例报告).中华消化外科杂志,2018,17:299-303.
10 钱震,刘会春,庞青,等.胆道支架植入联合125I粒子腔内照射治疗胰头癌临床疗效分析.现代医药卫生,2018,34:1123-1127.
11 Goutorbe F,Rouquette O,Mulliez A,et al.Temporary placement of a covered duodenal stent can avoid riskier anterograde biliary drainage when ERCP for obstructive jaundice fails due to duodenal invasion.Surg Endosc,2017,31:625-631.
12 李烽,张贵军,孙勤学,等.数字减影血管造影联合彩色多普勒超声引导经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的临床应用.现代实用医学,2018,30:22-23,27.
13 许显明.梗阻性黄疸行内镜下逆行胰胆管造影支架植入术后并发急性胆囊炎的影响因素.广西医学,2018,40:527-530.
14 董绪德,姜学远,王禹.肝囊肿致梗阻性黄疸1例报道.肝胆外科杂志,2018,26:80.
15 郑硕,黄奕红.超声引导经皮经肝胆道穿刺引流术治疗梗阻性黄疸50例分析.福建医药杂志,2018,40:78-80.