摘要
目的评价基于经皮肝穿刺胆道引流的不同退黄方案在恶性梗阻性黄疸治疗中的效果。方法选取2016年1月至2020年12月90例恶性梗阻性黄疸患者,按入院顺序依次分为SAMe-支持组(n=30)、MgIG-支持组(n=30)和SAMe-MgIG组(n=30),经皮肝穿刺胆道引流完成后,SAMe-支持组和MgIG-支持组在胆汁回输、肠内营养乳剂(TPF-T)支持基础上分别采用丁二磺酸腺苷蛋氨酸和异甘草酸镁护肝治疗,SAMe-MgIG组不进行胆汁回输和营养支持,采用两药联合护肝治疗;比较治疗前后三组肝生化(ALT、GGT、TBIL、PA、ALB)和炎症指标(TNF-α、IL-6)的变化及三组引流时间。结果治疗2周后,三组ALT、GGT、TBIL、TNF-α、IL-6均明显下降,PA、ALB则明显回升。三组ALT、GGT、TBIL、TNF-α及引流时间比较,差异无统计学意义(P>0.05),SAMe支持组PA和ALB改善快于MgIG-支持组和SAMe-MgIG组,差异有统计学意义(P<0.05),MgIG-支持组IL-6改善快于SAMe支持组和SAMe-MgIG组,差异有统计学意义(P<0.05);进一步两两比较,SAMe-支持组和MgIG-支持组PA、ALB、IL-6比较,差异无统计学意义(P>0.05),SAMe支持组和SAMe-MgIG组、MgIG-支持组和SAMe-MgIG组PA、ALB、IL-6比较,差异均有统计学意义(P<0.05)。结论 PTBD术后联合护肝无显著优势,单用丁二磺酸腺苷蛋氨酸或异甘草酸镁即可;护肝联合肠内营养乳剂(TPF-T)、胆汁回输治疗有助于促进转氨酶、胆红素、炎症反应及营养状况的同步改善。
Objective To evaluate the effects of different jaundice retreat schemes based on percutaneous transhepatic cholangiography and drainage in the treatment of malignant obstructive jaundice.Methods Ninety patients with malignant obstructive jaundice were selected from January 2016 to December 2020 and divided into the SAMe-support group(n=30),the MgIG-support group(n=30)and the SAMe-MgIG group(n=30)according to the order of admission.After percutaneous transhepatic cholangiography and drainage,the SAMe-support group and the MgIG-support group were treated with additional adenosylmethionine succinate and magnesium isoglycyrrhizinate liver protection,respectively,on the basis of bile reinfusion and enteral nutrition emulsion(TPF-T)support.The MgIG group were given both adenosylmethionine succinate and magnesium isoglycyrrhizinate liver protection,without bile reinfusion and nutritional support.The changes in liver biochemistry(ALT,GGT,TBIL,PA,ALB)and inflammation indicators(TNF-α,IL-6)before and after treatment,and drainage time were compared among the three groups.Results After 2 weeks of treatment,ALT,GGT,TBIL,TNF-α,IL-6 in the three groups were decreased significantly,while PA and ALB were increased significantly.There were no significant differences in ALT,GGT,TBIL,TNF-αand drainage time among the three groups(P>0.05).The improvements of PA and ALB in the SAMe-support group were faster than those in the MgIG-support group and the SAMe-MgIG group,with statistically significant differences(P<0.05).The improvement of IL-6 in the MgIGsupport group was faster than those in the SAMe-support group and the SAMe-MgIG group,with statistically significant differences(P<0.05).Further pairwise comparison indicated that there were no statistically significant differences in PA,ALB and IL-6 between the SAMe-support group and the MgIG-support group(P>0.05).There were statistically significant differences in PA,ALB and IL-6 between the SAMe-support group and the SAMe-MgIG group,between the Mg IG-support group and the SAMe-MgIG group(P<0.05).Conclusion There is no significant advantage in liver protection combination after PTBD.Single use of adenosylmethionine succinate or magnesium isoglycyrrhizinate is sufficient.Liver protection combined with enteral nutrition emulsion(TPF-T)and bile reinfusion promotes the simultaneous improvement of transaminase,bilirubin,inflammation and nutritional status.
作者
胥丹
韩保俊
黄凤德
蒲羽
XU Dan;HAN Baojun;HUANG Fengde;PU Yu(Department of Hepatobiliary Surgery,Sichuan Mianyang 404 Hospital,Mianyang 621000,China)
出处
《中国现代医生》
2021年第18期6-10,共5页
China Modern Doctor
基金
四川省绵阳市卫生健康委员会科研课题(201932)。
关键词
恶性梗阻性黄疸
丁二磺酸腺苷蛋氨酸
异甘草酸镁
肠内营养乳剂(TPF-T)
经皮肝穿刺胆道引流术
Malignant obstructive jaundice
Adenosylmethionine succinate
Magnesium isoglycyrrhizinate
Enteral nutrition emulsion(TPF-T)
Percutaneous transhepatic cholangiography and drainage
