2018 年第 8 期 第 13 卷

超声引导下肝内胆管穿刺引流术在老年高位恶性胆道梗阻患者中的临床应用效果

Clinical effect of ultrasound-guided intrahepatic bile duct puncture and drainage on elderly patients with malignant hilar biliary obstruction

作者：丁蕾张振刘福全

英文作者：

单位：100069首都医科大学附属北京佑安医院超声与功能诊断中心（丁蕾），肝胆外科中心（张振）；100038首都医科大学附属北京世纪坛医院肝胆外科（刘福全）

英文单位：

关键词：恶性胆道梗阻；肝内胆管穿刺引流；超声引导

英文关键词：

• 摘要：

• 【摘要】目的    探讨超声引导下肝内胆管穿刺引流术在老年高位恶性胆道梗阻患者中的临床应用效果。方法    选取2013年8月至2016年8月在首都医科大学附属北京佑安医院诊治的老年高位恶性胆道梗阻患者146例，采用随机数字表法分为观察组和对照组，每组73例。观察组采用超声引导下肝内胆管穿刺引流术治疗；对照组采用CT引导下肝内胆管穿刺引流术治疗。术前及术后7 d时检测患者血清总胆红素和直接胆红素水平。观察患者术后7 d并发症发生情况。术后随访12个月观察预后情况。结果    观察组一次穿刺成功率为100.0%（73/73）；对照组一次穿刺成功率为95.9%（70/73），有3例在二次穿刺时才获得成功。术后7 d，2组血清总胆红素和直接胆红素水平均较术前明显降低，且观察组血清总胆红素和直接胆红素水平明显低于对照组［（166±76）μmol/L比（202±78）μmol/L、（141±57）μmol/L比（178±61）μmol/L］，差异均有统计学意义(均P＜0.05)。观察组并发症发生率明显低于对照组［4.1%（3/73）比24.7%（18/73）］，差异有统计学意义（P＜0.05）。对照组患者生存期为（9.4±1.3）个月，观察组生存期为（10.0±1.4）个月，但组间比较差异无统计学意义（P＞0.05）。2组术后1、2、3、6、12个月生存率比较差异均无统计学意义（均P>0.05）。结论    超声引导下肝内胆管穿刺引流在老年高位恶性胆道梗阻患者的应用可提高穿刺成功率，有利于患者肝功能的恢复，减少术后并发症的发生，延长患者的生存时间。

• Objective    To analyze the clinical effect of ultrasound-guided intrahepatic bile duct puncture and drainage on elderly patients with malignant hilar biliary obstruction. Methods    A total of 146 elderly patients with malignant hilar biliary obstruction were enrolled from August 2013 to August 2016 in Beijing YouAn Hospital, Capital Medical University. The patients were randomly divided into observation group and control group, with 73 cases in each group. The observation group was treated with ultrasound-guided intrahepatic bile duct puncture and drainage. The control group was treated with CT-guided intrahepatic bile duct puncture and drainage. Serum levels of total bilirubin and direct bilirubin were tested before and 7 d after operation. Occurrence of complications was observed in 7 d after operation. Prognosis of patients was followed up in 12 months after operation. Results    The first time successful puncture rate was 100.0%（73/73） in observation group and 95.9%（70/73） in control group. At 7 d after operation, serum levels of total bilirubin and direct bilirubin significantly decreased compared to those before operation; serum levels of total bilirubin and direct bilirubin in observation group were significantly lower than those in control group［（166±76）μmol/L vs （202±78）μmol/L, （141±57）μmol/L vs （178±61）μmol/L］(P＜0.05). Incidence of postoperative complications in observation group was significantly lower than that in control group［4.1%（3/73） vs 24.7%（18/73）］(P＜0.05). Survival time of patients ［（9.4±1.3）months vs （10.0±1.4）months］ and the 1-, 2-, 3-, 6- and 12-month survival rates showed no significant differences between observation group and control group（P＞0.05）. Conclusion    Intrahepatic bile duct puncture and drainage with guidance of ultrasound treating elderly patients with malignant hilar biliary obstruction can improve the first time successful puncture rate, promote liver function recovery, reduce complications and improve postoperative survival.