史振軍 方嘉峰 黃水才

【摘要】 目的 探究分析超聲定位下經(jīng)皮肝膽管穿刺置管術(shù)治療惡性腫瘤致膽道梗阻的療效及對患者生活質(zhì)量的影響。方法 70例惡性腫瘤致膽道梗阻患者， 根據(jù)雙盲法將其分為甲組和乙組， 每組35例。甲組實(shí)施外科手術(shù)， 乙組實(shí)施超聲定位下經(jīng)皮肝膽管穿刺置管術(shù)。比較兩組患者治療效果以及手術(shù)前后的各項(xiàng)生化指標(biāo)[總膽紅素（TBIL）、直接膽紅素（DBIL）、白蛋白（ALB）、前白蛋白（PA）]水平、生活質(zhì)量（QOL）評分。結(jié)果 乙組治療總有效率97.1%高于甲組的80.0%， 差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。手術(shù)后， 兩組患者TBIL、DBIL、ALB、PA水平均有所改善， 且乙組患者TBIL水平（57.2±7.6）μmol/L、DBIL水平（34.2±5.1）μmol/L明顯低于甲組的（102.7±7.8）、（69.8±10.2）μmol/L， ALB水平（36.1±1.0）g/L、PA水平（181.2±4.0）mg/L均高于甲組的（32.8±1.5）g/L、（172.3±3.7）mg/L， 差異均具有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者QOL評分高于手術(shù)前， 且乙組患者QOL評分（44.5±4.2）分高于甲組的（34.0±3.9）分， 差異均具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 相較于常規(guī)外科手術(shù)治療， 超聲定位下經(jīng)皮肝膽管穿刺置管術(shù)治療惡性腫瘤致膽道梗阻， 療效、生化指標(biāo)改善情況以及患者生活質(zhì)量更為理想。

【關(guān)鍵詞】 經(jīng)皮肝膽管穿刺置管術(shù);超聲定位;外科手術(shù);惡性腫瘤致膽道梗阻;臨床療效

DOI：10.14163/j.cnki.11-5547/r.2020.22.011

Effect analysis of percutaneous hepatobiliary catheterization guided by ultrasound on biliary obstruction caused by malignant tumor? ?SHI Zhen-jun， FANG Jia-feng， HUANG Shui-cai. Department One of Surgery， Guangzhou Traditional Chinese Medicine Hospital， Guangzhou 510130， China

【Abstract】 Objective? ?To investigate the efficacy of percutaneous hepatobiliary catheterization guided by ultrasound on biliary obstruction caused by malignant tumor， and its influence on quality of life of patients. Methods? ?A total of 70 patients with biliary obstruction caused by malignant tumor were divided into group A and group B by double-blind method， with 35 cases in each group. Group A was treated by surgery， and group B was treated by percutaneous hepatobiliary catheterization. The therapeutic effect， biochemical indexes [total bilirubin （TBIL）， direct bilirubin （DBIL）， albumin （ALB）， prealbumin （PA）] before and after surgery and quality of life （QOL） score were compared between the two groups. Results? ?The total effective rate 97.1% of group B was higher than that of group A 80.0%， and the difference was statistically significant （P<0.05）. After surgery， the levels of TBIL， DBIL， ALB and PA of the two groups were improved， and TBIL （57.2±7.6） μmol/L， DBIL （34.2±5.1） μmol/L of group B were obviously lower than those of group A （102.7±7.8）， （69.8±10.2） μmol/L， and ALB （36.1±1.0） g， PA （181.2±

4.0） mg/L were higher than those of group A （32.8±1.5） g， （172.3±3.7） mg/L. The difference was statistically significant （P<0.05）. QOL score of the two groups was higher than those before surgery， and QOL score （44.5±4.2） points of group B was higher than that of group A （34.0±3.9） points， and the difference was statistically significant （P<0.05）. Conclusion? ?Compared with conventional surgery， percutaneous hepatobiliary catheterization under ultrasound location is more ideal in the treatment of biliary obstruction caused by malignant tumor， with better curative effect， biochemical index improvement and quality of life of patients.