摘要
目的探讨超声引导下的经皮肝穿刺胆道引流术(PTCD)应用于BismuthⅢ、Ⅳ型胆道梗阻患者的临床疗效。方法将95例恶性胆道梗阻患者中的BismuthⅢ型患者65例设为Ⅲ型组,BismuthⅣ型患者30例设为Ⅳ型组。比较两组患者手术时间、临床疗效及术后并发症发生情况,比较治疗前后肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBIL)和直接胆红素(DBIL)]水平及癌症患者生命质量测定量表(QLQ-C30)评分。结果Ⅲ型组患者手术时间短于Ⅳ型组,治疗总有效率高于Ⅳ型组(P<0.05或0.01)。治疗后两组患者血清ALT、AST、GGT、ALP、TBIL和DBIL水平均较治疗前降低,且Ⅲ型组低于Ⅳ型组(P<0.05或0.01)。治疗后两组患者QLQ-C30的总体健康状况、躯体功能、角色功能、情绪功能、认知功能、社会功能、疲乏、恶心呕吐、疼痛、呼吸困难、睡眠障碍、食欲丧失、便秘维度评分均较治疗前改善,Ⅲ型组患者QLQ-C30的总体健康状况、躯体功能、情绪功能、社会功能维度评分高于Ⅳ型组,而疲乏、恶心呕吐、疼痛、呼吸困难、睡眠障碍、食欲丧失、便秘维度评分低于Ⅳ型组(P<0.05或0.01)。Ⅲ型组患者术后并发症发生率低于Ⅳ型组,但差异无统计学意义(P>0.05)。结论相较于BismuthⅣ型胆道梗阻,超声引导下的PTCD应用于BismuthⅢ型胆道梗阻患者有较好的疗效,可以改善患者肝功能和生存质量。
Objective To explore the clinical effect of ultrasound-guided percutaneous transhepatic biliary drainage(PTCD)in patients with Bismuth typeⅢandⅣmalignant biliary obstruction.Methods Of 95 patients with malignant biliary obstruction 65 ones with Bismuth typeⅢwere set as groupⅢand 30 ones with typeⅣasⅣ.Such indexes were compared between two groups as time of operation,clinical effects,post-operation complications as well as pre-and post-operation liver function indicators(ALT,AST,GGT,ALP,TBIL,and DBIL)and scores on the quality of life questionnaire-core 30(QLQ-C30).Results The time of operation was shorter and total effective rate higher in groupⅢthanⅣ(P<0.05 or 0.01).After treatment serum ALT,AST,GGT,ALP,TBIL and DBIL levels in both groups lowered compared with pre-treatment and those were lower in groupⅢthanⅣ(P<0.05 or 0.01).After treatment general health status,physical function,role function,emotional function,cognitive function,social function,fatigue,nausea and vomiting,pain,shortness of breath,insomnia,loss of appetite,and constipation of the QLQ-C30 in both groups improved compared with pre-treatment,scores on the general health status,physical function,emotional function,and social function were were higher and those on fatigue,nausea and vomiting,pain,shortness of breath,insomnia,loss of appetite,and constipation lower inⅢthanⅣgroup(P<0.05 or 0.01).The incidence of postoperative complication was lower in inⅢthanⅣgroup,but difference wasn't statistically significant(P>0.05).Conclusion Ultrasound-guided PTCD has a better effect on Bismuth typeⅢmalignant biliary obstruction and could improve liver function and quality of life compared with Bismuth typeⅣ.
作者
常志扬
马会民
段少博
张椰
王帅羊
张连仲
Chang Zhiyang;Ma Huimin;Duan Shaobo;Zhang Ye;Wang Shuaiyang;Zhang Lianzhong(Henan Provincial People's Hospital,Zhengzhou 450000,Henan,China)
出处
《临床心身疾病杂志》
CAS
2024年第1期50-54,共5页
Journal of Clinical Psychosomatic Diseases
基金
河南省卫生健康科技英才海外研修工程(编号HWYX2019136)。
