魏建,尉建安,胡跃峰,苏天昊,尹超,栗荐,金龙.对比单、双侧经皮肝穿刺胆管引流术治疗Ⅳ型肝门部胆管癌并发恶性梗阻性黄疸[J].中国介入影像与治疗学,2022,19(6):333-337
对比单、双侧经皮肝穿刺胆管引流术治疗Ⅳ型肝门部胆管癌并发恶性梗阻性黄疸
Comparison on unilateral and bilateral percutaneous transhepatic cholangial drainage for treating type Ⅳ hilar cholangiocarcinoma complicated with malignant obstructive jaundice
投稿时间:2021-12-24  修订日期:2022-03-29
DOI:10.13929/j.issn.1672-8475.2022.06.004
中文关键词:  胆管肿瘤  黄疸,梗阻性  穿刺术  引流  生活质量
英文关键词:bile duct neoplasms  jaundice, obstructive  punctures  drainage  quality of life
基金项目:
作者单位E-mail
魏建 首都医科大学附属北京友谊医院放射介入科, 北京 100050  
尉建安 首都医科大学附属北京友谊医院放射介入科, 北京 100050  
胡跃峰 首都医科大学附属北京友谊医院放射介入科, 北京 100050  
苏天昊 首都医科大学附属北京友谊医院放射介入科, 北京 100050  
尹超 首都医科大学附属北京友谊医院放射介入科, 北京 100050  
栗荐 首都医科大学附属北京友谊医院放射介入科, 北京 100050  
金龙 首都医科大学附属北京友谊医院放射介入科, 北京 100050 longerg@hotmail.com 
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中文摘要:
      目的 对比单、双侧经皮肝穿刺胆管引流术(PTCD)治疗Ⅳ型肝门部胆管癌并发恶性梗阻性黄疸的效果。方法 对51例Ⅳ型肝门部胆管癌并发恶性梗阻性黄疸患者行PTCD,对其中单侧组23例行透视引导下经右侧腋中线肋间隙穿刺右肝管及分支(13例)或经剑突下穿刺左肝管及分支(10例)置管引流,28例(双侧组)行经右侧腋中线肋间隙穿刺联合经剑突下穿刺置管引流。分别于PTCD前及后2周检测血清总胆红素(TBIL),计算TBIL每周递减率(WDR)。记录PTCD后1个月内并发症情况;于其后1~2个月以欧洲癌症研究与治疗组织生活质量测定量表(EORTC-QLQ-C30)及恶性梗阻性黄疸患者特异性条目池(QLQ-MOJ11)评估患者生活质量。结果 2组均顺利完成置管引流,术中均未出现不良反应或并发症。2组间术前及术后TBIL水平及连续2周WDR≥30%者占比差异均无统计学意义(P均>0.05)。QLQ-C30量表评价结果显示,在功能领域,双侧组躯体功能、角色功能、情绪功能、社会功能、总体健康状况得分均高于单侧组(P均<0.05);而在症状领域,双侧组疼痛得分高于单侧组(P<0.05);组间单一条目差异均无统计学意义(P均>0.05),QLQ-MOJ11各条目得分差异亦无统计学意义(P均>0.05)。双侧组术后胆道感染、胰腺炎、出血、腹痛发生率高于单侧组,而引流管移位/脱出及更换引流管次数均少于单侧组(P均<0.05)。结论 单侧及双侧PTCD均可有效缓解Ⅳ型肝门部胆管癌合并恶性梗阻性黄疸症状;单侧引流后患者生活质量优于、并发症少于双侧引流,但易出现引流管移位等情况。
英文摘要:
      Objective To comparatively observe the therapeutic effect of unilateral and bilateral percutaneous transhepatic cholangial drainage (PTCD) for type Ⅳ hilar cholangiocarcinoma complicated with malignant obstructive jaundice. Methods PTCD was performed in 51 patients with Ⅳ hilar cholangiocarcinoma complicated with malignant obstructive jaundice under fluoroscopic guidance. Twenty-three patients in unilateral group underwent catheter drainage through the right hepatic duct and its branch through right midaxillary intercostal space (13 cases) or left hepatic duct and its branch through the xiphoid process (10 cases), while 28 in bilateral group received puncture through the right midaxillary intercostal space combined with drainage through subxiphoid process. Serum total bilirubin (TBIL) was detected 2 weeks before and after PTCD, respectively, and the weekly diminishing rate (WDR) of TBIL was calculated. The complications within 1 month after PTCD were recorded. Quality of life was assessed 1 to 2 months after PTCD using European organization for research and treatment of cancer quality of life core questionnaire (EORTC-QLQ-C30) and patient-specific entry pool for malignant obstructive jaundice (QLQ-MOJ11). Results Catheter drainage was successfully completed in both groups, and no adverse reaction nor complication occurred during PTCD. There was no significant difference of preoperative and postoperative TBIL levels between groups, nor the ratios of patients with WDR ≥30% for 2 consecutive weeks (all P>0.05). Taken QLQ-C30 scale, in the functional area, the scores of physical function, role function, emotional function, social function and overall health status in bilateral group were higher than those in unilateral group (all P<0.05), while in for symptom area, the score of pain in bilateral group was higher than that in unilateral group (P<0.05). No significance difference of in single item was found between groups (all P>0.05). The scores of QLQ-MOJ11 items were not significant different between groups (all P>0.05). The incidence of postoperative biliary tract infection, pancreatitis, bleeding and abdominal pain in bilateral group was higher than those in unilateral group, and the occurrences of drainage tube displacement/prolapse and drainage tube replacement in bilateral group were less than that in unilateral group (all P<0.05). Conclusion Both unilateral and bilateral PTCD could effectively relieve symptoms of type Ⅳ hilar cholangiocarcinoma complicated with malignant obstructive jaundice. Unilateral drainage could result better postoperative life quality and fewer complications, but more often drainage tube displacement, etc.
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