本文選題：腹腔熱灌注治療 + 惡性梗阻性黃疸��； 參考：《新鄉(xiāng)醫(yī)學院》2017年碩士論文

【摘要】：背景惡性梗阻性黃疸是由于惡性腫瘤引起的直接或者間接膽道梗阻擴張并以高膽紅素血癥、組織和體液黃染為主要臨床表現(xiàn)的疾病,如胰腺癌、膽管癌、十二指腸乳頭癌以及其它惡性腫瘤轉移和復發(fā)壓迫膽管等。其常引起免疫系統(tǒng)功能損傷、呼吸功能減弱、腎臟功能衰竭等嚴重反應,極大增加了惡性腫瘤患者的死亡率。腹腔熱灌注治療是近年興起的治療腹腔惡性腫瘤的有效方法。探討腹腔熱灌注治療在惡性梗阻性黃疸疾病中的減黃作用,既可以有效治療惡性腫瘤,又可以減少惡性梗阻性黃疸引起的并發(fā)癥,從而在提高患者生活質量以達到延長生存期的治療目的中發(fā)揮重要作用。目的探討腹腔熱灌注治療(Hyperthermic Intraperitoneal Chemotherapy,HIPEC)對惡性梗阻性黃疸的臨床減黃作用,為HIPEC治療惡性腫瘤提供新途徑。方法選取2015年7月至2016年10月于新鄉(xiāng)醫(yī)學院第一附屬醫(yī)院普外科治療的具有完整臨床資料的膽管癌、膽囊癌、胰頭癌、壺腹周圍癌及其他腫瘤復發(fā)或轉移壓迫膽管者共39例,行手術解除膽道梗阻(根治術或姑息性切除術)后,行腹腔熱灌注治療者納入治療組(18例,46%),未行腹腔熱灌注者納入對照組(21例,54%),對兩組臨床資料進行回顧性分析,檢測治療組和對照組患者術前1天、術后第1天、術后第4天、術后第7天血清總膽紅素(Total Bilirubin TBIL)、直接膽紅素(Direct Bilirubin DBIL)、血清堿性磷酸酶(Lkaline Phosphatase ALP)相關指標水平,采用重復測量方差分析,P0.05為差異有統(tǒng)計學意義。結果術前1天治療組與對照組血清TBIL、DBIL、ALP含量無統(tǒng)計學差異,治療組術后第1天、術后第4天、術后第7天血清TBIL明顯低于對照組(F=12.63,P0.01)、DBIL明顯低于對照組(F=26.68,P0.01)、ALP明顯低于對照組(F=21.76,P0.01)。結論HIPEC對惡性梗阻性黃疸術后早期有快速減黃作用。
[Abstract]:Background malignant obstructive jaundice is a major clinical manifestation of direct or indirect biliary obstruction caused by malignant neoplasms with hyperbilirubinemia, tissue and body fluid yellow staining, such as pancreatic cancer and cholangiocarcinoma. Duodenal papillary carcinoma and other malignant tumors metastasis and recurrent compression of the bile duct. It often causes serious reactions such as impaired immune system, weakened respiratory function and renal failure, which greatly increases the mortality rate of patients with malignant tumor. Peritoneal hyperthermic therapy is an effective method for the treatment of peritoneal malignant tumors. To investigate the effect of intraperitoneal hyperthermic perfusion on malignant obstructive jaundice, which can not only effectively treat malignant tumors, but also reduce the complications caused by malignant obstructive jaundice. Therefore, it plays an important role in improving the quality of life of patients in order to prolong the survival. Objective to investigate the clinical effect of hyperthermic intraperitoneal chemotherapy (HIPEC) on malignant obstructive jaundice and to provide a new approach for the treatment of malignant tumors. Methods from July 2015 to October 2016, 39 cases of cholangiocarcinoma, gallbladder carcinoma, pancreatic head carcinoma, periampullary carcinoma and other tumors were treated by general surgery in the first affiliated Hospital of Xinxiang Medical College. After operation to relieve biliary obstruction (radical operation or palliative resection), the patients who received abdominal hyperthermic perfusion therapy were included in the treatment group (18 cases, 46%) and the control group (21 cases, 54%). The clinical data of the two groups were analyzed retrospectively. Serum total bilirubin (TBIL), direct bilirubin (DBIL) and alkaline phosphatase (ALP) were measured in the treatment group and the control group on the first day before operation, on the first day after operation, on the fourth day after operation and on the seventh day after operation. The use of repeated measurement of variance analysis of P 0.05 as the difference was statistically significant. Results there was no significant difference in serum TBILD ILP levels between the treatment group and the control group one day before operation. The serum TBIL levels in the treatment group were significantly lower than those in the control group on the 1st day, the 4th day and the 7th day after operation. The level of serum TBIL in the treatment group was significantly lower than that in the control group (FF26.68 / P0.01) and the ALP was significantly lower than that in the control group (FF21.76 / P0.01). Conclusion HIPEC can reduce jaundice in early stage after malignant obstructive jaundice.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R730.5

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