摘要
目的:探讨开腹胆-肠吻合及经皮胆道双支架植入在恶性高位梗阻性黄疸患者临床治疗中的应用价值。方法:回顾分析49例不能根治切除的高位恶性梗阻性黄疸患者的临床资料及随访情况,按手术方式分为支架组(n=28)和胆肠吻合组(n=21)。结果:所有患者均一次性完成胆-肠吻合术或胆道双支架植入以达到内引流的目标。2组肝功能指标:总胆红素(TBIL)、谷草转氨酶(ALT)、谷丙转氨酶(AST)、碱性磷酸酶(AKP)均在术后l周出现明显下降(P<0.05),组间比较差异无统计学意义(P>0.05)。2组中胆肠吻合组平均生存时间(22.96±7.83)周,胆道支架植入组平均生存时间(28.67±1.69)周,差异无统计学意义(P>0.05);2组住院天数、单次住院费用比较,差异有统计学意义(P<0.05),其中胆肠吻合组平均住院时间为(27.55±31.35)d,胆道支架植入组为(12.62±4.17)d,胆肠吻合组平均住院费用为(54881.99±16816.57)元,胆道支架植入组为(42650.00±11450.08)元。围手术期死亡1例(胆肠吻合组),死亡率2.04%,考虑为术后感染性休克导致多器官功能衰竭。术后主要并发症有胆管炎、胰腺炎、胆道支架移位或堵塞、胆道感染、肝功能衰竭。结论:开腹胆肠吻合及经皮胆道支架植入均可有效解除恶性胆道梗阻,改善肝功能,延长生存期。但从住院天数、费用等经济学指标来观察,胆道支架植入更具优势。
Purpose:To investigate the value of open biliary-intestinal anastomosis and percutaneous biliary double stenting in the clinical treatment of patients with malignant high-grade obstructive jaundice.Methods:The clinical data and follow-up of 49 patients with high-grade malignant obstructive jaundice that could not be resected radically were retrospectively analyzed and divided into the stent group(n=28)and the bile-intestinal anastomosis group(n=21)according to the surgical procedure.Results:All patients underwent bile-intestinal anastomosis or biliary double stenting to achieve the goal of internal drainage in a single operation.The mean survival time was(22.96±7.83)weeks in the biliary-intestinal anastomosis group and(28.67±1.69)weeks in the biliary stent implantation group,with no statistically significant difference(P>0.05);the difference in the number of hospitalization days and single hospitalization cost was statistically significant(P<0.05)between the two groups.The average length of stay was(27.55±31.35)d in the bile-intestinal anastomosis group and(12.62±4.17)d in the biliary stent implantation group,and the average hospitalization cost was(54881.99±16816.57)yuan in the bile-intestinal anastomosis group and(42650.00±11450.08)yuan in the biliary stent implantation group.There was one perioperative death(bile-intestinal anastomosis group)with a mortality rate of 2.04%,which was considered to be postoperative infectious shock leading to multi-organ failure.The main postoperative complications were biliary ductitis,pancreatitis,biliary stent displacement or obstruction,biliary tract infection,and liver failure.Conclusion:Both open bile-intestinal anastomosis and percutaneous biliary stenting can effectively relieve malignant biliary obstruction,improve liver function,and prolong survival.However,biliary stenting is more advantageous in terms of the number of days of hospitalization,cost and other economic indicators.
作者
范晨
孙飞虎
周琦
王卫东
FAN Chen;SUN Feihu;ZHOU Qi;WANG Weidong(Department of Intervention,The Affiliated Wuxi People's Hospitalof Nanjing Medical University)
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2022年第1期78-81,共4页
Chinese Computed Medical Imaging
关键词
肝门
恶性梗阻
胆道支架
胆-肠吻合
Hilar
Malignant obstruction
Biliary stent
Cholangiojejunostomy
