【作者】 白爱国；

【导师】 郑传胜；

【作者基本信息】 华中科技大学 ， 医学影像学， 2007， 硕士

【摘要】 目的:研究B超结合透视行胆道引流的技术经验;比较PTBD和PTBS的并发,近期疗效和长期疗效;分析短期死亡病例的术前危险因素。材料和方法:210例阻塞性黄疸患者,在B超结合透视引导下行胆道引流术。其中161例置入塑料引流管,49例置入金属支架。临床诊断肝癌32例、胆管癌61例、胆囊癌10例、胰腺癌17例,转移癌62例,诊断不明确而诊为肝门占位者28例。术前总胆红素平均320.12 umol/l,直接胆红素183.75umol/l。随访资料通过电话回访或是复检记录获取。所有数据均采用spss13.0软件包进行统计,采用的统计检验方法为,两独立样本均数t检验,四格表资料卡方分析,单向方差分析,Kaplan-meier生存分析。结果:技术成功率为百分之百,金属支架组15例,术后3～5天血清总胆红素平均下降178.04±42.32umol/l,直接胆红素平均下降83.97±23.63 umol/l,塑料引流管组28例,术后3～5天血清总胆红素平均下降95.67±34.28umol/l,直接胆红素平均下降49.84±28.21umol/l,两者的差别有显著性统计学意义(P=0.017,P=0.035)。金属支架组28例,术后6～9天血清总胆红素平均下降188.22±79.90umol/l,塑料引流管组126例,术后6～9天血清总胆红素平均下降141.39±65.32umol/l,两者的差别有显著性统计学意义(P=0.014),术后6～9天两者直接胆红素下降值没有显著性差异(P=0.567)。金属支架组并发生发生率为8%,塑料引流管组为52%,前者远低于后者(P=0.000),且大部分并发症与穿刺程序无关。金属支架组和塑料引流管组的中位通畅期和中位生存期分别是197天,245天和60天,148天,两组比较均有统计学差异,P<0.05。二个月内死亡危险因素有高龄,较差的肝功能,异常的肾功能,术前感染,肿瘤侵及范围和血红蛋白含量。结论:B超结合透视引导下行胆道引流简便安全,成功率高。金属支架较塑料引流管近期和远期疗较好。有条件患者,应尽量置入金属支架。更多还原

【Abstract】 Objective: to evaluate the technique of PTCD under the guidence of ultrasound with DSA;to compare the complications,short-term and long-term clinical efficacy of plastic drainage catheters with metalic stents;to analyse the risk factors of early mortality.Materials and Methods:210 cases of malignant obstructive jaundice,of which 161 cases of plastic drainage catheters placement and 49 cases of metalic stents implantation,included 32 patients with clinical diagnosis of hepatocellular carcinoma, cholangiocarcinoma 61 cases, 10 cases of gallbladder cancer, 17 cases of pancreatic cancer. 62 patients with metastatic cancer, and 28 cases were diagnosed as hilar mass.The mean serum total bilirubin before treatment was 320.12 umol/l,and direct bilirubin 183.75 umol/l. Follow-up information obtained through telephone review or reinterventional records.All datas were analysed with spss11.5 statistical software package.The statistical test methods included two independent samples t test, chi-square analysis for table 4 georgia, one-way analysis of variance and Kaplan-meier survival analysis. Results : The success rate of technique was 100%.3~5days after treatment, the serum total bilirubin of 15 metalic stents cases decreased 178.04±42.32umol/l, and direct bilirubin fell 83.97±23.63 umol/l.28 plastic cathers : 95.67±34.28umol/l, 49.84±28.21umol/l. The differences between metalic stent group and plastic drainage catheter group were statistically significant (P = 0.017. P =0.035). After 6-9 days, the serum total bilirubin of 28 cases of metalic stent group fell 188.22±79.90umol/l,and of 126 cases of plastic drainage catheter group was 141.39±65.32umol/l. The difference had statistic significance (P = 0.014).But the decline value of direct bilirubin was no significant difference.The complication rate of metalic stent group was 8%(4/49), 52%(84/161) of plastic drainage catheter group .The former was far lower than the later(P=0.000). Most of them have no relation with the puncture procedure. The median patency period and the median survival time of the group of plastic drainage catheter were 60 days , 148 days,the metalic stent 197 days, 245 days. There were statistically significant differences(P<0.05). Risk factors are age, poor liver function, abnormal renal function, infection before treatment, and the site of tumor invasion and hemoglobin content.Conclusion: PTCD under the guidence of ultrasound with DSA is a safe ,simple method with a high success rate in treatment of malignant obstructive jaundice.Metalic stents have better short-term and long-term efficacy.更多还原