終末期肝泡型包蟲病合并梗阻性黃疸的診治分析
發(fā)布時(shí)間：2018-08-21 08:03
【摘要】：目的：探討治療合并梗阻性黃疸的終末期肝泡型包蟲病的方法及療效。方法：回顧性分析從2000年1月至2013年1月在新疆醫(yī)科大學(xué)一附院診治的55例終末期肝泡型包蟲病合并梗阻性黃疸患者的臨床資料。根據(jù)患者的不同治療方案進(jìn)行分組,A組：姑息性手術(shù)組(姑息性病灶切除加膽道減壓術(shù)組)38例(69.1%)和B組：介入組(經(jīng)皮經(jīng)肝膽道引流術(shù)組,即PTCD組)17例(30.9%)。比較兩組的一般資料、術(shù)前、術(shù)后3-7d的肝功能指標(biāo)、手術(shù)時(shí)間、出血量、平均住院天數(shù)、術(shù)后帶膿腔引流管時(shí)間、病灶繼續(xù)浸潤和(或)轉(zhuǎn)移、膽道并發(fā)癥(術(shù)后膽汁瘺、膽管炎、再次并發(fā)梗阻性黃疸)、死亡率、累積生存率、生存曲線等指標(biāo)。計(jì)量資料采用t或t檢驗(yàn),計(jì)數(shù)資料采用,檢驗(yàn),生存分析采用Kaplan-Meier法計(jì)算生存率,并行Log Rank檢驗(yàn)。結(jié)果：A組的手術(shù)時(shí)間、出血量、平均住院天數(shù)明顯高于B組(P0.05),而術(shù)后總膽紅素、直接膽紅素、r-谷氨酰轉(zhuǎn)肽酶、堿性磷酸酶下降水平?jīng)]有B組明顯(P0.05),而且A組的術(shù)后門冬氨酸氨基轉(zhuǎn)移酶、丙氨酸氨基轉(zhuǎn)移酶、白蛋白受損傷水平較B組嚴(yán)重(P0.05)。A、B兩組的一般資料(性別、年齡、民族)、術(shù)前肝功能指標(biāo)、術(shù)后帶膿腔引流管時(shí)間、病灶繼續(xù)浸潤和(或)轉(zhuǎn)移、膽道并發(fā)癥、死亡率、累積生存率、生存曲線相比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：介入治療是終末期肝泡型包蟲病合并梗阻性黃疸患者的一種有效治療方法,具有微創(chuàng)、簡便、安全、可重復(fù)性等優(yōu)點(diǎn),可以代替?zhèn)鹘y(tǒng)的姑息性手術(shù)治療。同時(shí),可以對此類患者的肝移植治療爭取時(shí)間,甚至為根治性切除創(chuàng)造機(jī)會。
[Abstract]:Objective: to investigate the treatment method and curative effect of end-stage hepatic alveolar hydatid disease with obstructive jaundice. Methods: the clinical data of 55 patients with end-stage hepatic alveolar hydatidosis complicated with obstructive jaundice were retrospectively analyzed from January 2000 to January 2013 in the first affiliated Hospital of Xinjiang Medical University. The patients were divided into two groups: group A (n = 38): palliative resection group (n = 38) and group B (n = 17): percutaneous transhepatic biliary drainage group (n = 17) (30.9%). The general data of the two groups were compared. The indexes of liver function, the time of operation, the amount of blood loss, the average days of hospitalization, the time of drainage with pus cavity after operation, the continuous infiltration and / or metastasis of the lesions, the complications of biliary tract (postoperative biliary fistula) were compared between the two groups before and after operation. Cholangitis, secondary obstructive jaundice), mortality, cumulative survival rate, survival curve and other indicators. T or t test was used for measurement data, Kaplan-Meier method was used to calculate survival rate and Log Rank test was used for counting data and survival analysis. Results the operative time, blood loss and average hospital stay in group A were significantly higher than those in group B (P0.05), while the total bilirubin, direct bilirubin and r-glutamyl transpeptidase (GTP) in group A were significantly higher than those in group B (P0.05). The decreased level of alkaline phosphatase was not significant in group B (P0.05), and the levels of aspartate aminotransferase, alanine aminotransferase and albumin in group A were more serious than those in group B (P0.05). There was no significant difference in preoperative liver function, postoperative drainage time with pus cavity, continuous infiltration and / or metastasis, biliary complications, mortality, cumulative survival rate and survival curve (P0.05). Conclusion: interventional therapy is an effective method for patients with end-stage hepatic alveolar hydatidosis complicated with obstructive jaundice. It has the advantages of minimally invasive, simple, safe and repeatable, and can replace the traditional palliative operation. At the same time, it can buy time and even create opportunities for radical resection of liver transplantation in such patients.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R532.32
本文編號：2195073
[Abstract]:Objective: to investigate the treatment method and curative effect of end-stage hepatic alveolar hydatid disease with obstructive jaundice. Methods: the clinical data of 55 patients with end-stage hepatic alveolar hydatidosis complicated with obstructive jaundice were retrospectively analyzed from January 2000 to January 2013 in the first affiliated Hospital of Xinjiang Medical University. The patients were divided into two groups: group A (n = 38): palliative resection group (n = 38) and group B (n = 17): percutaneous transhepatic biliary drainage group (n = 17) (30.9%). The general data of the two groups were compared. The indexes of liver function, the time of operation, the amount of blood loss, the average days of hospitalization, the time of drainage with pus cavity after operation, the continuous infiltration and / or metastasis of the lesions, the complications of biliary tract (postoperative biliary fistula) were compared between the two groups before and after operation. Cholangitis, secondary obstructive jaundice), mortality, cumulative survival rate, survival curve and other indicators. T or t test was used for measurement data, Kaplan-Meier method was used to calculate survival rate and Log Rank test was used for counting data and survival analysis. Results the operative time, blood loss and average hospital stay in group A were significantly higher than those in group B (P0.05), while the total bilirubin, direct bilirubin and r-glutamyl transpeptidase (GTP) in group A were significantly higher than those in group B (P0.05). The decreased level of alkaline phosphatase was not significant in group B (P0.05), and the levels of aspartate aminotransferase, alanine aminotransferase and albumin in group A were more serious than those in group B (P0.05). There was no significant difference in preoperative liver function, postoperative drainage time with pus cavity, continuous infiltration and / or metastasis, biliary complications, mortality, cumulative survival rate and survival curve (P0.05). Conclusion: interventional therapy is an effective method for patients with end-stage hepatic alveolar hydatidosis complicated with obstructive jaundice. It has the advantages of minimally invasive, simple, safe and repeatable, and can replace the traditional palliative operation. At the same time, it can buy time and even create opportunities for radical resection of liver transplantation in such patients.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R532.32
【參考文獻(xiàn)】
相關(guān)期刊論文 前5條
1 阿依甫汗·阿汗;吐爾干艾力;邵英梅;溫浩;;肝包蟲病的外科治療現(xiàn)狀[J];肝膽外科雜志;2009年01期
2 潘光棟,嚴(yán)律南,李波,盧實(shí)春,曾勇,文天夫,趙紀(jì)春,程南生,馬玉奎,王文濤,楊家印,李志輝,王新平;肝移植治療晚期泡型肝包蟲病五例[J];中華器官移植雜志;2005年07期
3 李作安;吐爾干艾力·阿吉;冉博;溫浩;邵英梅;;“減體積式病灶肝切除”治療晚期肝巨大泡型包蟲病的臨床應(yīng)用[J];中國普通外科雜志;2012年07期
4 Giuseppe Nunnari;Marilia R Pinzone;Salvatore Gruttadauria;Benedetto M Celesia;Giordano Madeddu;Giulia Malaguarnera;Piero Pavone;Alessandro Cappellani;Bruno Cacopardo;;Hepatic echinococcosis:Clinical and therapeutic aspects[J];World Journal of Gastroenterology;2012年13期
5 張金輝;趙晉明;邵英梅;季學(xué)聞;邰沁文;李濤;吐爾干·艾力;何翼彪;溫浩;;活體肝移植治療終末期肝病患者12例[J];中華肝臟外科手術(shù)學(xué)電子雜志;2013年01期
，本文編號：2195073
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