摘要
目的研究双通道直视胃镜诊治毕Ⅱ式胃大部切除术后低位胆道梗阻的疗效和安全性,为胃大部切除术后低位胆道梗阻的诊治提供依据。方法选取2013年1月—2015年5月于如皋市第四人民医院进行治疗的毕Ⅱ式胃大部切除术后低位胆道梗阻患者67例。以数字法随机分为观察组33例,对照组34例。观察组进行双通道直视胃镜诊治,对照组则给予传统十二指肠镜治疗。对比2组疗效,血清总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平,并发症发生情况以及术后6个月、12个月病死率。结果观察组治疗总有效率为87.88%(29/33),显著高于对照组的64.71%(22/34),组间差异有统计学意义(Z=-2.097,P<0.05);观察组TBIL、ALT、AST水平恢复正常时间均显著低于对照组,组间差异有统计学意义(t=4.235、4.482、4.401,均P<0.05);治疗期间观察组出血和肠穿孔发生率分别为3.03%和0.00%均显著低于对照组20.59%、14.71%,组间差异有统计学意义(χ2=4.910、5.244,均P<0.05)。观察组术后6个月以及12个月病死率分别为12.12%和21.21%均显著低于对照组的35.29%和50.00%,组间差异有统计学意义(χ2=4.947、6.057,均P<0.05)。结论双通道直视胃镜诊治毕Ⅱ式胃大部切除术后低位胆道梗阻效果显著,应用安全,可以有效降低术后并发症发生率,降低胆红素和转氨酶水平,对延长病患生命有重要意义,值得临床推广应用。
Objective To study the efficacy and safety of double-channel endoscope in the diagnosis and treatment of low- level bile duct obstruction after Billroth IⅡsubtotal gastreetomy. Methods A total of 67 cases of low-level bile duct ob- struction after Billroth Ⅱ subtotal gastrectomy in our hospital between January, 2013 and May, 2015 were enrolled and randomly divided into observation group （33 cases）and control group （34 cases ）. The dual channel direct vision endoscopy was performed in the observation group, while traditional endoscopic treatment was performed in the control group. The curative effect,the level of serum total bilirubin（ TBIL）, alanine aminotransferase （ALT） and aspartate aminotransferase （AST）, incidence of complication, and mortality during postoperative 6 months and 12 months were compared between the two groups. Results The total effective rate in the observation group was 87.88% （29/33） ,which was significantly high- er than that of control group 64.71% （ 22/34, Z = - 2. 097, P 〈 0.05 ） ; the serum total bilirubin （ TBIL）, alanine amin- otransferase （ ALT）, aspartate aminotransferase （AST） levels were significantly lower than control group （ t = 4. 235,4. 482, 4.401 ,P 〈 0.05 ）. The incidence of bleeding and intestinal perforation rate was 3.03% and 0.00% during the treatment in the observation group,which were significantly lower than those（20.59% and 14.71% ） in the control group（ χ2 = 4. 910,5. 244,P 〈0.05）. The mortality rates in the observation group during 6 months and 12 month after the operation were 12.12% and 21.21%, respectively,which were significantly lower than 35.29% and 50% in the control group, the differences was statistically significant （ χ2 = 4. 947,6. 057, P 〈 0.05 ）. Conclusion The effect of double-channel endo- scope is distinct in the diagnosis and treatment of ow-level bile duct obstruction after Billroth Ⅱ subtotal gastreetomy. It can effectively ireduce the incidence of complications, prolong ser
出处
《中华全科医学》
2016年第11期1873-1875,共3页
Chinese Journal of General Practice
关键词
双通道直视胃镜
毕Ⅱ式胃大部切除术
低位胆道梗阻
疗效
Double-channel endoscope
BillrothⅡ subtotal gastrectomy
Low-level biliary obstruction
Curative effect
