超声引导下经皮肝穿刺胆道引流术治疗对恶性梗阻性黄疸的危重症评分及肝功能的影响

摘要/Abstract

摘要： 目的探究超声引导下经皮肝穿刺胆道引流术(PTCD)治疗对恶性梗阻性黄疸(MOJ)的危重症评分及肝功能的影响。方法选取2021年2月至2023年11月核工业四一六医院接收的76例MOJ患者,按信封抽签法随机分为ERCP组(n=38)和PTCD组(n=38)。ERCP组给予经内镜逆行胰胆管造影(ERCP)治疗,PTCD组给予超声引导下PTCD治疗。比较两组围术期指标,治疗前后肝功能、免疫指标、危重症评分及并发症。结果 PTCD组的手术时间(52.37±4.28)min、穿刺次数(2.07±0.17)次、胆汁引流量(3.69±0.23)L、有效带管时间(12.52±1.09)d、首次下床时间(3.15±0.26)d均低于ERCP组,分别为(61.87±5.34 )min、(4.26±0.33)次、(4.74±0.25)L、(17.43±1.56)d、(4.69±0.32)d,均P<0.05。治疗后,PTCD组的TBil(154.38±13.71)μmol/L、DBil(116.35±9.21 )μmol/L、AST(87.44±6.82)IU/L、GGT(89.44±7.67)IU/L,均低于ERCP组,分别为(174.85±16.18)μmol/L、(134.82±11.03) μmol/L、(105.03±8.71)IU/L、(112.03±10.32)IU/L,均P<0.05;PTCD组的IgA(2.63±0.26 )g/L、IgM(10.56±1.05)g/L、IgG(12.33±1.20)g/L、CD4⁺(39.22±4.07)％、CD4⁺/CD8⁺(1.77±0.16)均高于ERCP组,分别为(1.80±0.17)g/L、(7.97±0.80)g/L、(9.60±1.10)g/L、(35.41±3.70)%、(1.25±0.12);CD8⁺(22.33±2.46)%,低于ERCP组(26.41±2.77)%,P<0.05;PTCD组的全身炎症反应综合征(SIRS)评分(1.20±0.16)分、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分 (6.83±0.42)分、序贯器官衰竭评估(SOFA)评分(2.64±0.15)分,均低于ERCP组(1.78±0.27、8.15±0.61、3.35±0.25)分,均P<0.05。ERCP组和PTCD组的并发症发生率比较(7.9% vs. 13.2%),差异无统计学意义(P>0.05)。结论超声引导下PTCD治疗对MOJ的危重症评分及肝功能的影响较为显著。

关键词: 超声, 经皮肝穿刺胆道引流术, 危重症评分, 肝功能

Abstract: Objective To explore the impact of ultrasound-guided percutaneous transhepatic cholangiography drainage (PTCD) on severity scoring and liver function in patients with malignant obstructive jaundice (MOJ). Methods From February 2021 to November 2023, 76 MOJ patients were admitted to the Nuclear Industry 416 Hospital and randomly divided into two groups using the envelope drawing method: the ERCP group (n=38) and the PTCD group (n=38). The ERCP group received endoscopic retrograde cholangiopancreatography (ERCP) treatment, while the PTCD group underwent ultrasound-guided PTCD. Perioperative indicators, liver function, immune markers, severity scores, and complications were compared between the two groups before and after treatment. Results The surgery time (52.37±4.28 minutes), number of punctures (2.07±0.17 times), bile drainage volume (3.69±0.23 liters), effective catheterization time (12.52±1.09 days), and first ambulation time (3.15±0.26 days) of the PTCD group were all lower than those of the ERCP group (61.87±5.34 minutes, 4.26±0.33 times, 4.74±0.25 liters, 17.43±1.56 days, and 4.69±0.32 days, respectively) (P<0.05). After treatment, the levels of TBil (154.38±13.71 μmol/L), DBil (116.35±9.21 μmol/L), AST (87.44±6.82 IU/L), and GCT (89.44±7.67 IU/L) in the PTCD group were lower than those in the ERCP group (174.85±16.18 μmol/L, 134.82±11.03 μmol/L, 105.03±8.71 IU/L, and 112.03±10.32 IU/L, respectively) (P<0.05). The levels of IgA (2.63±0.26 g/L), IgM (10.56±1.05 g/L), IgG (12.33±1.20 g/L), CD4⁺ (39.22±4.07%), and CD4⁺/CD8⁺ (1.77±0.16) in the PTCD group were higher than those in the ERCP group (1.80±0.17 g/L, 7.97±0.80 g/L, 9.60±1.10 g/L, 35.41±3.70%, and 1.25±0.12, respectively), while CD8⁺ (22.33±2.46%) was lower than that in the ERCP group (26.41±2.77%) (P<0.05).The systemic inflammatory response syndrome (sSIRS) score (1.20±0.16), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score (6.83±0.42), and Sequential Organ Failure Assessment (SOFA) score (2.64±0.15) in the PTCD group were all lower than those in the ERCP group (1.78±0.27, 8.15±0.61, and 3.35±0.25, respectively) (P<0.05). There was no statistically significant difference in the complication rates between the ERCP and PTCD groups (13.2% vs. 10.5%) (P>0.05). Conclusion Ultrasound-guided PTCD has a positive effect on severity scoring and liver function in patients with MOJ.

Key words: Ultrasound, Percutaneous transhepatic cholangiography drainage, Severity scoring, Liver function

程序, 田治军, 李凯. 超声引导下经皮肝穿刺胆道引流术治疗对恶性梗阻性黄疸的危重症评分及肝功能的影响[J]. 肝脏, 2025, 30(8): 1142-1146.

CHENG Xu, TIAN Zhi-jun, LI Kai. Impact of ultrasound-guided percutaneous transhepatic cholangiography drainage on severity scoring and liver function in malignant obstructive jaundice[J]. Chinese Hepatolgy, 2025, 30(8): 1142-1146.

/ 推荐

参考文献

[1] Pang L, Wu S, Kong J. Comparison of efficacy and safety between endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangial drainage for the treatment of malignant obstructive jaundice: a systematic review and meta-analysis[J]. Digestion, 2023, 104(2): 85-96.
[2] Sheng Y, Fu X, Wang G, et al. Safety and efficacy of self-expandable metallic stent combined with 125I brachytherapy for the treatment of malignant obstructive jaundice[J]. Cancer Imaging, 2023, 23(1): 1-12.
[3] 吴小云, 李领, 王春玲, 等. 胆汁回输在恶性梗阻性黄疸患者经皮肝穿刺胆道引流术术后应用的研究进展[J]. 浙江医学,2023,45(13):1443-1445.
[4] 房达, 高文峰, 杜宁, 等. 胆道梗阻经皮肝穿刺胆道引流术患者辐射剂量的分析[J]. 北京医学,2022,44(10):914-916.
[5] 钟海, 陈剑挺, 胡小龙, 等. 新型胆道引流管固定装置在经皮肝穿刺胆道引流术后患者中的应用效果[J]. 广西医学,2023,45(18):2280-2282,2290.
[6] 莫伟, 刘智超, 阳秀春, 等. 透明敷料联合粘性敷料在经皮肝穿刺胆道引流术管路固定的应用[J]. 介入放射学杂志,2022,31(4):397-400.
[7] 张路生, 曾福强, 邹斌, 等. 超声造影对恶性胆道梗阻性黄疸经皮肝穿刺胆道引流术引流效果的影响[J]. 中国医学装备,2022,19(3):98-102.
[8] 张正乐, 赵传兵, 李汉军, 等. 经皮经肝胆囊穿刺引流在急性胰腺炎合并胆囊炎或胆道梗阻的临床应用价值[J]. 腹部外科,2023,36(1):45-49.
[9] 丘文凤, 廖金明, 吴洁, 等. 早期连续性血液净化联合腹腔微创穿刺引流对重症急性胰腺炎腹内压、肝功能及炎症因子的影响[J]. 中国现代医学杂志,2022,32(9):91-96.
[10] 朱梦莉, 王智超, 张婧, 等. 全身炎症反应综合征评分、序贯器官衰竭评分、快速脓毒症相关器官功能障碍评分对急诊感染性疾病预后的评估价值[J]. 安徽医药,2021,25(2):261-264.
[11] Bian C, Fang Y, Xia J, et al. Is percutaneous drainage better than endoscopic drainage in the management of patients with malignant obstructive jaundice? A meta-analysis of RCTs[J]. Frontiers in Oncology, 2023, 13: 1105728.
[12] Lianyuan T, Hongsheng X, Xuxiang Z, et al. An alternative palliative surgical method for advanced malignant obstructive jaundice: laparoscopic bridge choledochoduodenostomy[J]. Frontiers in Surgery, 2023, 9: 1056093.
[13] 俞雪, 刘艳, 沈天皓, 等. 经皮肝穿刺胆道引流术联合125I粒子条治疗肝内胆管细胞癌合并恶性梗阻性黄疸的临床疗效观察[J]. 现代消化及介入诊疗,2023,28(4):497-501.
[14] 张银, 张悦, 陈炳芳, 等. 超声内镜引导与经皮肝穿刺胆道引流应用于梗阻性黄疸患者的疗效评价[J]. 东南国防医药,2022,24(2):133-137.
[15] 宋小伟, 熊妮, 曹爱萍, 等. 超声定位导向经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的临床研究[J]. 中西医结合肝病杂志,2023,33(3):227-229,233.
[16] 牛旭, 冯章东, 张腾, 等. 经皮肝穿刺胆道引流术和内镜下胆管内引流术对晚期恶性梗阻性黄疸患者围术期指标和术后并发症的影响[J]. 川北医学院学报,2022,37(3):378-381,410.
[17] Atilla A, Taşkιn M H, Kazak Z, et al. GP73 level in patients with chronic hepatitis B: relationship with liver biopsy, levels of ALT, AST and HBV DNA[J]. Indian Journal of Pathology and Microbiology, 2022, 65(1): 55-58.
[18] 贾楠, 刘兆玉. 经皮肝穿刺胆道引流术和胆道支架置入术治疗恶性胆道梗阻的术后并发症及其危险因素研究进展[J]. 中国医药,2021,16(8):1261-1264.
[19] 张宇飞, 何亮, 徐国栋, 等. 经皮肝穿刺胆道引流术联合腹腔镜胆囊切除术在老年急性胆囊炎患者中的应用效果及对胆囊组织中巨噬细胞的影响[J]. 广西医学,2021,43(15):1801-1804.
[20] 李海文, 杨河, 李萌. 经皮肝穿刺胆道引流术治疗高位恶性梗阻性黄疸对患者肝功能的影响分析[J]. 中国医学装备,2021,18(5):109-112.