摘要
目的观察经皮经肝穿刺胆道引流术(PTCD)联合胆汁回输对低位恶性梗阻性黄疸胰十二指肠切除术(PD)手术的影响。方法回顾性分析2015年10月至2017年10月我院收治的63例低位恶性梗阻性黄疸患者,根据治疗方案分为观察组33例及对照组30例。观察组患者入院完善术前检查后行PTCD引流并胆汁回输,肝功改善后行PD手术。对照组患者于入院5 d内行PD手术。比较观察组减黄前后的各项生化指标;比较2组患者术前TBIL水平、术中出血量、住院时间、住院费用、并发症发生率、围手术期死亡率等。结果观察组TBIL、PA、CD3^+CD4^+、CD3^+CD8^+、CD3^+CD4^+/CD3^+CD8^+减黄后均较减黄前改善,差异有统计学意义(P<0.05);观察组平均住院时间为(40.9±10.6)d,对照组为(28.1±11.3)d,观察组平均总费用为(9.96±2.19)万元,对照组为(7.46±1.99)万元,2组平均住院时间及费用比较,差异有统计学意义(P<0.05)。结论 PTCD联合胆汁回输治疗低位恶性梗阻性黄疸能够促进患者术后消化功能恢复,提高免疫力,从而降低术后感染及胃排空延迟发生率,但会增加住院时间及费用。
Objective To investigate the effects of percutaneous transhepatic cholangio drainage（ PTCD） combined with bile reinfusion on the lower malignant obstructive jaundice pancreaticoduodenectomy（ PD）. Methods A total of 63 patients with lower malignant obstructive jaundice who were admitted in our hospital from October 2015 to October 2017 were prospectively enrolled in this study. And they were classified into the observation group（ n = 33） and the control group（ n = 30） by the treatment plan,respectively. The patients in the observation group underwent PD after receiving PTCD combined with bile reinfusion. Meanwhile,the patients in the control group received PD within 5 days after admission to hospital. Biochemical assay was performed in the patients of observation group to compare the biochemical indexes. The preoperative total bilirubin（ TBIL） level,intraoperative blood loss,hospital stay and cost,complications,perioperative mortality were compared in the patients between two groups. Results TBIL,PA,CD3＋CD4＋,CD3＋CD8＋,and CD3＋CD4＋/CD3＋CD8＋were increased significantly in the patients after PTCD combined with bile reinfusion and the difference was statistically significant（ P〈 0. 05）. The average hospitalization days in the observation group was（ 40. 9 ± 10. 6） days,which was more than（ 28. 1 ± 11. 3） days in the control group. In addition,the average cost was also increased significantly in the observation group[（ 99 600 ± 21 900） yuan] over the control group [（ 74 600 ± 19 900）yuan],and the differences in average hospital stay and cost between the two group were of statistical significance（ P〈 0. 05）. Conclusion PTCD combined with bile reinfusion for the treatment of lower malignant obstructive jaundice could improve the patients＇ digestive function and immunity and reduce the incidence of postoperative infection and delayed gastric emptying. However,the hospital stay period and cost were increased accordingly.
作者
王泽锋
肖瑞
赵磊
郝粉娥
杨景瑞
任建军
WANG Ze-feng;XIAO Rui;ZHAO Lei;HAO Fen-e;YANG Jin-ru;REN Jian-jun(Department of Image Center,Affiliated Hospital of Inner Mongolia Medical University,Hohhot Inner Mongolia 010050,China;Key Laboratory of Molecular Pathology,Inner Mongolia Medical University,Hohhot Inner Mongolia 010050,China;Department of Hepatobiliary Surgery,Affiliated Hospital of Inner Mon-golia Medical University,Hohhot Inner Mongolia 010050,China)
出处
《局解手术学杂志》
2018年第6期414-418,共5页
Journal of Regional Anatomy and Operative Surgery
基金
内蒙古自治区自然科学基金项目(2107MS0834)
内蒙古医科大学临床医学教学研究项目(NYJXGG2017127)
内蒙古草原英才(CYYC6013)
内蒙古医科大学附属医院重大科研项目(NYFYZD)
