本文選題：姑息性減黃術(shù) + 惡性膽道梗阻�。� 參考：《鄭州大學》2017年碩士論文

【摘要】：研究背景惡性膽道梗阻(malignant biliary obstruction,MBO)是指惡性腫瘤壓迫或侵犯肝外膽管,引起膽道狹窄,從而導致膽汁排泄受阻。主要表現(xiàn)為黃疸、上腹痛、發(fā)熱以及繼發(fā)性肝功能惡化,嚴重者可發(fā)生膿毒血癥、肝腎功能衰竭、凝血功能異常,病死率極高。若不采取及時治療,其預后較差,平均生存期不足3個月。92%的患者半年內(nèi)死亡。根治性手術(shù)切除率較低,姑息性膽道引流減黃術(shù)成為有效手段。目前臨床上常用的姑息性治療手段有外科手術(shù)、內(nèi)鏡下支架置入、經(jīng)皮經(jīng)肝膽道穿刺引流。近年來,研究不同引流方法的療效和安全性成為研究的熱點。目的通過回顧性分析我院分別行姑息性膽腸吻合術(shù)、內(nèi)鏡下引流術(shù)(endoscopic retrograde cholangio-pancreatography,ERCP)、經(jīng)皮肝穿刺膽道引流術(shù)(percutaneous transhepatic cholangial drainage,PTCD)不同方法的臨床資料,對其臨床特點及優(yōu)缺點做出客觀評價,為臨床醫(yī)生提供參考。方法2011年5月至2015年7月期間我院收治的不能行根治性手術(shù)切除的惡性膽道梗阻患者共193例,按內(nèi)鏡下膽道支架置入術(shù)、經(jīng)皮肝穿刺膽道引流術(shù)和姑息性膽腸吻合術(shù)三種治療方法分別分成ERCP組、PTCD組和膽腸吻合組,收集三組患者的臨床資料,并對三組患者肝功能指標、術(shù)后近期并發(fā)癥、住院時間和生存時間進行回顧性分析。結(jié)果1.一般資料方面,各組患者的男女比例、平均年齡、發(fā)病原因等比較均無統(tǒng)計學差異(P0.05),三組資料具有可比性。2.在惡性膽道梗阻的就診首發(fā)癥狀中,皮膚及鞏膜黃染最多見,其次為乏力、腹痛腹脹、畏寒發(fā)熱等,基本與文獻相符。3.在治療效果方面,三組患者ALT、TBIL、ALP、GGT術(shù)后均出現(xiàn)明顯下降,與術(shù)前相比差異具有統(tǒng)計學意義(P0.05)。各組間術(shù)后下降情況比較差異無統(tǒng)計學意義(P0.05)。術(shù)后通過隨訪比較發(fā)現(xiàn),三組患者的平均生存期比較差異無統(tǒng)計學意義(P0.05)。4.ERCP組并發(fā)癥發(fā)生率較PTCD組及膽腸吻合組明顯降低,差異具有統(tǒng)計學意義(P0.05)。PTCD組較膽腸吻合組術(shù)后近期并發(fā)癥發(fā)生率降低,比較差異有統(tǒng)計學意義(P0.05)。5.ERCP組和PTCD組的平均住院時間相較膽腸吻合組更短,差異具有統(tǒng)計學意義(P0.05)。而ERCP組和PTCD組相比較無明顯差異(P0.05)。結(jié)論ERCP、PTCD、膽腸吻合術(shù)均能有效的實現(xiàn)膽道引流、降低黃疸、保護肝功能、延長患者生存期。都是姑息性治療惡性膽道梗阻的有效方法。ERCP較另外兩種治療方法有一定的治療優(yōu)勢,可在臨床積極推廣。
[Abstract]:Background malignant biliary obstruction (malignant biliary) is defined as the compression or invasion of extrahepatic bile duct by malignant tumor, which leads to biliary stricture, which leads to obstruction of bile excretion. The main manifestations were jaundice, epigastric pain, fever and secondary deterioration of liver function. In severe cases, sepsis, liver and kidney failure, abnormal coagulation function and high mortality were found. Without timely treatment, the prognosis was poor, and the average survival time was less than 3 months. 92% of the patients died within half a year. The resection rate of radical operation is low, palliative biliary drainage is an effective method. At present, the commonly used palliative treatment is surgery, endoscopic stent placement, percutaneous transhepatic biliary drainage. In recent years, research on the efficacy and safety of different drainage methods has become a hot topic. Objective to analyze the clinical data of different methods of palliative choledochostomy, endoscopic drainage (endoscopic retrograde cholangio-creatography) and percutaneous transhepatic biliary drainage (percutaneous transhepatic cholangial drainage PTCD) in our hospital, and to evaluate their clinical features, advantages and disadvantages. To provide reference for clinicians. Methods from May 2011 to July 2015, 193 patients with malignant biliary obstruction who could not be resected by radical operation were treated by endoscopic biliary stenting. Three methods of percutaneous transhepatic biliary drainage and palliative choledochojejunostomy were divided into two groups: ERCP group, PTCD group and choledochojejunostomy group. The clinical data of the three groups were collected. The hospitalization time and survival time were analyzed retrospectively. Result 1. General data, the ratio of men and women in each group, the average age, the cause of the disease were not statistically significant differences (P0.05), the three groups of comparable data. 2. Among the first symptoms of malignant biliary obstruction, yellow staining of skin and sclera was the most common, followed by fatigue, abdominal pain and abdominal distension, chilling fever, etc. In the treatment effect, the three groups of patients with alt TBILL ALP GGT decreased significantly after operation, compared with the preoperative difference was statistically significant (P0.05). There was no significant difference between the two groups (P0.05). It was found that there was no significant difference in the mean survival time among the three groups (P0.05) .4.The incidence of complications in ERCP group was significantly lower than that in PTCD group and choledochojejunostomy group. The incidence of postoperative complications in PTCD group was significantly lower than that in choledochojejunostomy group (P0.05). 5. The average hospitalization time of ERCP group and PTCD group was shorter than that of choledochojejunostomy group (P0.05). There was no significant difference between ERCP group and PTCD group (P0.05). Conclusion ERCP PTCD and cholangiojejunostomy can effectively achieve biliary drainage, reduce jaundice, protect liver function and prolong the survival time of the patients. ERCP is an effective method for palliative treatment of malignant biliary obstruction. ERCP has some advantages over the other two methods and can be popularized in clinic.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R730.5

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