摘要
目的比较可切除肝门部胆管癌术前经皮肝穿刺胆道引流(PTBD)及经逆行胰胆管造影(ERCP)内支架引流两种减黄方式的治疗效果,探讨最佳的术前引流方式。方法对2004年1月—2011年1月期间58例可切除的肝门部胆管癌术前行PTBD(35例)或ERCP(23例)减黄的患者的临床资料进行比较分析,比较两组的操作成功率、并发症发生率、胆道感染发生率以及引流效果。结果两组患者术前一般资料无统计学差异,PTBD组的操作成功率达100%,而ERCP组为87%(P=0.057);PTBD组2例出现胆道出血;而ERCP组出现1例十二指肠穿孔,2例十二指肠乳头出血,4例急性胰腺炎。ERCP组胆道感染的发生率高于PTBD组(43%vs.17%,P=0.028);两组均能于开腹手术前达到有效减黄,但ERCP组需时长于PTBD组(7周vs.4.5周,P=0.035),且更换引流物次数更多(2.5次vs.1.2次,P=0.029)。ERCP组8例(34.8%)需转为PTBD处理,其胆道感染的发生率为75.0%,平均需要进行4次更换引流物,术前平均引流时间为8周。PTBD组2例(5.7%)因胆汁引流量大(超过2000mL/d)转为ERCP内支架引流。结论对于可切除的肝门部胆管癌患者,术前PTBD比ERCP内支架放置更有优越性,操作的并发症和胆道感染少,需更换引流物的次数更少。但是临床上需要根据患者的具体情况作出相应的选择。
Objective To compare the efficacy of two types of preoperative biliary drainage procedure [percutaneous transhepatic biliary drainage（PTBD） vs.stent drainage through endoscopic retrograde cholangiopancreatography（ERCP）] for recectable hilar cholangiocarcinoma. Methods The clinical data of 58 patients with resectable hilar cholangiocarcinoma undergoing preoperative biliary drainage with PTBD（35 cases） or ERCP（23 cases） from January 2004 to January 2011 were analyzed.The success rate of operation,incidence of complications and biliary tract infection as well as the drainage effects between the two groups were compared. Results The preoperative medical data of the patients between the two groups had no statistical differences.The success rate of initial drainage was 100% in the PTBD and 87% in the ERCP group（P=0.057）.Two cases of biliary tract bleeding occurred in PTBD group;while one case of duodenal perforation,2 cases of papilla bleeding and 4 cases of acute pancreatitis occurred in ERCP group.The incidence of biliary tract infection of ERCP group was significantly higher than that of PTBD group（43% vs.17%,P=0.028）.The jaundice was reduced to a satisfactory level before surgery in both groups.However,longer drainage period and more drain replacements were required in ERCP group than those in PTBD group（7 weeks vs.4.5 weeks,P=0.035;2.5 times vs.1.2 times,P=0.029）.Eight cases（34.8%） in ERCP group were converted to PTBD procdure,of which the biliary tract infection rate was 75.0%,mean drain replacement was 4 times and mean drainage period was 8 weeks before surgery,respectively.Two cases（5.7%） of PTBD group were converted to ERCP internal drainage due to large volume of bile outflow（more than 2 000 mL/d）. Conclusions For resectalbe hilar cholangiocarcinona patients preoperaive PTBD has more advantages than ERCP stent placement,showing fewer procedure-related complications and biliary infections and requiring less drain replacements,but the selection of which procedure to perform in clinical practice should be based on the particular conditions of the patients.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2011年第8期844-847,共4页
China Journal of General Surgery
