武中林 1李顺宗 1杨光 1吴勇超 1荣小翠 1李智岗1
作者信息
- 1. 050011河北省石家庄市,河北医科大学第四医院放射介入科
- 折叠
摘要
Abstract
Objective To compare the clinical effectiveness of percutaneous transhepatic cholangial drainage (PTCD) via different approaches guided by digital subtraction angiography (DSA) for the treatment of malignant high biliary obstruction (MHBO).Methods One hundred and sixty-four patients with MHBO who received treatment in Fourth Hospital of Hebei Medical University from January 2010 to January 2014 were enrolled and divided into 4 groups according to the treatment:18 cases received DSA-guided complete external drainage of biliary tract (group A),34 cases received DSA-guided external drainage of biliary tract via the site observed to bring the most favorable outcome (group B),48 cases received biliary single stent implantation combined with external drainage of biliary tract via the area contralateral to the stent implantation site (group C),and 64 cases received biliary double stent implantation (group D).Level of biochemical indicators of hepatic function,such as alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBIL) and direct bilirubin (DBIL) measured within 3 days before surgery and on the 3rd,7th,14th days after surgery,and TBIL measured at 21st day after surgery were recorded.Also,perioperative conplications of therapy were recorded.According to the levels of biochemical indicators of hepatic function measured during the follow-up period,the short-term and long-term effects achieved in the groups were evaluated.Results Both the approach and duration of biliary drainage produced interactive effects on the changes in the levels of biochemical indicators of hepatic function (ALT,AST,TBIL,DBIL) (P ＜0.05),and both of them exerted main effects on the changes in biochemical indicators of hepatic function (ALT,AST,TBIL,DBIL) (P ＜ O.05).Biliary-cardiac reflex,bile duct bleeding and pain at the puncture site occurred more frequently in group D compared with group A,B,but lower than group C (P ＜0.05);while electrolyte disturbance occurred less frequently in group D rather than in other three groups (P ＜ O.05).No significant difference was seen in the short-term effect (x2 =1.405,P =0.70).No obvious difference was found in 1-year survival rate (x2 =1.801,P =0.62).The survival curves of the 4 groups were compared,the difference was statistically significant (P ＜ 0.01).Median survival time was found to be longer in groups C and D than that in group A (P ＜ 0.05).Compared with group D,groups B and C demonstrated shorter median survival time (P ＜ 0.05).Conclusion The effect of reducing MHBO-induced jaundice is determined by the size of drained area.The greater the drained area is the better effect of reducing jaundice will be achieved.Therefore,internal biliary drainage is better than external biliary drainage.Biliary double stent implantation used for internal biliary drainage can recover the bile enterohepatic circulation,rapidly reduce the MHBO-induced jaundice,recover the hepatic function,improve the quality of life and prolong the survival time.关键词
胆汁淤积/血管造影术,数字减影/引流术/治疗结果/疗效比较研究Key words
Cholestasis/Angiography, digital subtraction/Drainage/Treatment outcome/Comparative effectiveness research分类
医药卫生
