一步法超声引导经皮经肝胆道引流术治疗高龄胆道梗阻的探讨

One-step ultrasound-guided percutaneous transhepatic cholangiographic drainage in treatment of bile duct obstruction in the elderly

摘要:

目的 探讨一步法超声引导经皮经肝胆道引流术（PTCD）治疗高龄（＞60岁）胆道梗阻的有效性、可行性及安全性。方法 回顾性地分析147例行一步法PTCD的高龄胆道梗阻患者，分析手术时间、费用、术前及术后血清总胆红素（STB）水平、病程及并发症，并比较穿刺成功率和并发症发生率在不同性别、年龄、病程、术前STB、肝内胆管内径及梗阻病因中的差异。结果 147例患者穿刺成功127例（86.4%）。穿刺成功率在不同性别及梗阻病因方面差异无统计学意义，而在不同年龄、病程、术前STB、肝内胆管内径方面差异有统计学意义（P<0.05）。穿刺成功者术后并发症共17例（13.4%），发生率在术前STB水平及恶性梗阻方面差异有统计学意义（P<0.05）。结论 一步法PTCD是治疗高龄胆道梗阻的一项安全、有效的方法，其穿刺成功率与患者病程、胆道梗阻程度及病因有相关性，并发症的发生率与患者术前血清STB水平及梗阻病因密切相关。

Abstract:

Objective To investigate the efficacy, feasibility and safety of the one-step ultrasound-guided percutaneous transhepatic cholangiographic drainage (PTCD) in treatment of bile duct obstruction in aged patients (>60 years old). Methods Clinical data of 147 old patients who underwent one-step PTCD with bile duct obstruction in our department from December 2012 to August 2015 were collected and retrospectively analyzed. The operation time, cost, duration of the disease, incidence of complications, preoperative and postoperative levels of serum total bilirubin (STB), were analyzed. The success rate of one-step puncture, and the incidence of complications were compared in different groups of gender, age, duration of the disease, preoperative STB level, preoperative diameter of bile duct and the causes of obstruction. Results There were 127 (86.4%) cases undergoing successful one-step PTCD. No significant difference was seen in the success rate of operation among the patients of different genders and with different causes of obstruction, but obvious differences were observed in patients at different ages and with different duration of disease, preoperative STB level, and preoperative diameter of bile duct (P<0.05). There were 17 patients experiencing postoperative complications, and significant differences were seen among those of different STB level and of benign and malignant obstruction (P<0.05). Conclusion One-step PTCD is a safe and effective treatment for bile duct obstruction in aged patients. Its success rate of puncture is associated with the duration of disease, severity and cause of bile duct obstruction. The incidence of complications is closely related to the preoperative level of STB and causes of obstruction.