论文部分内容阅读
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 preoperative percutaneous transhepatic biliary drainage (PTBD) with resectable hilar cholangiocarcinoma (HEPD) treated with stent-graft reduction by retrograde cholangiopancreatography (ERCP) and discuss the best preoperative drainage. Methods The clinical data of 58 patients with resectable hilar cholangiocarcinoma who underwent preoperative PTBD (35 cases) or ERCP (23 cases) diminished from January 2004 to January 2011 were compared. Two groups were compared The success rate of operation, the incidence of complications, the incidence of biliary tract infection and drainage. Results There was no statistically significant difference in preoperative data between the two groups. The success rate of operation in PTBD group was 100%, while that in ERCP group was 87% (P = 0.057); biliary tract hemorrhage occurred in 2 patients in PTBD group and 1 patient in ERCP group Duodenal perforation, 2 cases of duodenal papillary hemorrhage, 4 cases of acute pancreatitis. The incidence of biliary tract infection in ERCP group was higher than that in PTBD group (43% vs.17%, P = 0.028). Both groups were effective in reducing yellow before open surgery, but ERCP group took longer than PTBD group .4.5 weeks, P = .035) and had more diversions (2.5 vs. 1.2 times, P = 0.029). Eight patients (34.8%) in ERCP group were treated with PTBD. The incidence of biliary tract infection was 75.0%. On average, 4 drainage replacements were required. The mean preoperative drainage time was 8 weeks. Two patients (5.7%) in the PTBD group were converted to ERCP stent drainage due to large biliary drainage (over 2000 mL / d). Conclusions For patients with resectable hilar cholangiocarcinoma, the preoperative PTBD is superior to the ERCP stent placement. Complications and biliary tract infections are fewer and the need to replace the drainage is fewer. But the clinical need to make the appropriate choice according to the specific circumstances of patients.