本文選題：泡型肝包蟲病　切入點(diǎn)：PTBD　出處：《青海大學(xué)》2017年碩士論文

【摘要】：目的:通過對比PTBD和ERCP治療HAE合并梗阻性黃疸患者的療效,為臨床選擇一種更優(yōu)的方法來緩解晚期HAE患者的黃疸情況提供參考。方法:收集青海大學(xué)附屬醫(yī)院2012年1月至2016年9月就診的初步診斷為肝包蟲病患者的病例資料,按納入排除標(biāo)準(zhǔn)篩選符合條件的HAE合并梗阻性黃疸患者,分為PTBD組和ERCP組,比較兩組患者的術(shù)后療效、住院費(fèi)用及預(yù)后情況。結(jié)果:1.共收集病例治療資料1189例,其中符合納入排除標(biāo)準(zhǔn)41例,行PTBD治療23例,行ERCP治療18例。兩組患者的年齡、性別、民族、包蟲抗體、HBV感染、病灶位置、病灶大小、梗阻部位、病灶壞死、N分期、M分期、術(shù)前手術(shù)史、術(shù)前肝功能分級等指標(biāo)差別均無統(tǒng)計(jì)學(xué)意義(P0.05);PTBD組術(shù)前重度以上黃疸的患者較ERCP組多,ERCP組病灶鈣化和處于P1、P2期的患者較PTBD組多(P0.05)。2.PTBD組和ERCP組患者術(shù)后一般狀況較前好轉(zhuǎn),術(shù)后不同時期兩組TBIL、DBIL、TBA、γ-GT、ALP等黃疸指標(biāo)較術(shù)前均明顯下降(P0.05);術(shù)后TBIL下降程度,PTBD組較ERCP組更明顯(P0.05)。3.術(shù)后兩組間ALT、AST、CHE、ALB、PT、APTT、PLT等其它肝功能指標(biāo)差別無統(tǒng)計(jì)學(xué)意義(P0.05)。4.在入院時和出院時患者黃疸比較,PTBD組和ERCP組患者TBIL水平均下降,差別有統(tǒng)計(jì)學(xué)意義(P0.01);在入院時和出院時肝功能Child分級比較上,PTBD組差別有統(tǒng)計(jì)學(xué)意義(P0.05),ERCP組差別無統(tǒng)計(jì)學(xué)意義(P0.05)。5.術(shù)前ALB水平是影響HAE患者術(shù)前黃疸程度的保護(hù)性因素(P0.05,OR1)。6.膽囊炎、術(shù)前ALB、術(shù)前PLT是影響HAE患者術(shù)后是否發(fā)生并發(fā)癥的保護(hù)性因素(P0.05,OR1),病灶M分期是影響HAE患者預(yù)后的保護(hù)性因素(P0.05,HR1)。7.PTBD組治療費(fèi)用低于ERCP組(P0.05),但兩組間住院總費(fèi)用差別無統(tǒng)計(jì)學(xué)意義(P0.05)。8.兩組間在術(shù)后并發(fā)癥發(fā)生率和預(yù)后生存率方面差別無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:PTBD和ERCP均有效降低HAE患者膽紅素及梗阻性黃疸相關(guān)肝功能指標(biāo)水平,改善患者一般情況,但兩者均未明顯改善非黃疸直接相關(guān)肝功能指標(biāo)。PTBD和ERCP在術(shù)后并發(fā)癥發(fā)生率和預(yù)后生存率方面可能沒有差異。PTBD相比于ERCP操作簡單,治療費(fèi)用更低,但兩者住院總費(fèi)用無差別。
[Abstract]:Objective: to compare the efficacy of PTBD and ERCP in the treatment of HAE with obstructive jaundice. To provide a reference for clinical selection of a better method to alleviate jaundice in patients with advanced HAE. Methods: data of patients with hepatic hydatidosis diagnosed in the affiliated Hospital of Qinghai University from January 2012 to September 2016 were collected. According to the exclusion criteria, HAE patients with obstructive jaundice were selected and divided into two groups: PTBD group and ERCP group. The curative effect, hospitalization cost and prognosis of the two groups were compared. Among them, 41 cases were included in the exclusion criteria, 23 cases were treated with PTBD and 18 cases were treated with ERCP. The age, sex, nationality, hydatid antibody infection, location, size, site of obstruction and N stage M stage of lesion necrosis were observed in the two groups. History of preoperative surgery, There was no significant difference in preoperative liver function grading between patients with severe jaundice before operation and patients with severe jaundice before operation in ERCP group than those in PTBD group with more calcification and P1P _ 2 stage than those in PTBD group. 2. The general postoperative status of patients in PTBD group and ERCP group was better than that in PTBD group. The jaundice indexes such as TBILD DBILP TBA, 緯 -GTT ALP in two groups were significantly lower than those before operation (P 0.05), and the degree of TBIL decrease after operation in PTBD group was significantly higher than that in ERCP group (P 0.05. 3). There was no significant difference between the two groups in other liver function indexes such as ALB PTTTPLT and so on. The level of TBIL in patients with jaundice was lower than that in patients with ERCP and PTBD. The difference was statistically significant (P 0.01), and there was no significant difference in Child grade of liver function between admission and discharge. Preoperative ALB level was a protective factor affecting the degree of preoperative jaundice in HAE patients (P 0.05 OR1. 6). Preoperative ALB, preoperative PLT is a protective factor influencing the occurrence of postoperative complications in patients with HAE (P0.05 OR1). The M stage of lesion is a protective factor affecting the prognosis of HAE patients. The cost of treatment in the PLT group is lower than that in the ERCP group, but there is no difference in total hospitalization cost between the two groups. There was no significant difference between the two groups in the incidence of postoperative complications and the survival rate of prognosis. Conclusion both ERCP and ERCP can effectively reduce the level of bilirubin and liver function related to obstructive jaundice in patients with HAE. There may be no difference in the incidence of postoperative complications and survival rate between PTBD and ERCP. Compared with ERCP, the operation of PTBD is simpler and the cost of treatment is lower than that of ERCP. But there was no difference in the total cost of hospitalization between the two groups.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.3

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