| Objective:To explore the clinical benefit of percutaneous transhepatic biliary drainage combined with the supplement of extrinsicbile into the intestine for the treatment of malignant obstructive jaundice.Methods: Sixty patients with malignant obstructive jaundice,who received interventional treatment in the Affiliated Hospital of Zunyi Medical University from March 2014 to December 2015,were retrospectively reviewed and analyzed. According to the different treatment strategies,the patients were divided into the observation group(n = 32),using PTBD combined with the supplement of extrinsicbile into the intestine.The control group(n = 28),take merely percutaneous transhepatic biliary drainage(PTBD).Regarding those two treatment groups, the clinical data including bilirubin, child- pugh grade, nutritional status, the color of feces, itchy skin, diet, and related complications of one month prior and post to intervention treatment were compared and analyzed.Results: The index of the two groups was compared based on the preoperative observation. The P value is larger than 0.05 and there is no statistical significance(P>0.05).Interventional procedures,32 patients of observation group were punctured while the success rate is 100%.32 biliary drainage tubes were implanted,and the bile was successfully indwelled into the intestine via the same piercing way.28 patients of the control group were punctured while the successful rate is 100%. 28 biliary drainage tube were implanted.All of them were successful at the first time. Curative effect observation of two groups patients.The bilirubin index and Child- Pugh grade:Preoperative of intervention treatment, the total bilirubin(TBIL), direct bilirubin(DBIL) and indirect bilirubin(IBIL)of the patients in observation group were,351.55±174.63μmol/L, 184.25±88.55μmol/L167.79±92.02μmol/L.And the patients in control group were 365.06±135.57 μmol/L,194.32±78.78μmol/L,170.39±67.17μmol/L. One month after the intervention treatment, the total bilirubin(TBIL), direct bilirubin(DBIL) and indirect bilirubin(IBIL)of the patients in observation group were 144.60±115.63μmol/L,76.45±61.49μmol/L,67.83±54.72μmol/L.And the patients in control group were 173.96±96.48μmol/L,94.83±53.91μmol/L,80.86±47.08μmol/L. Compared with the preoperative levels,the bilirubin index of the two groups dropped significantly. and the differences were statistically significant(P< 0.05). the comparison between the two groups, there was no statistically significant difference(P > 0.05).Child- Pugh grade,Prior to the surgery, grade A,B, C patientsin the observation group was 5, 25, and 2, while the control group was9, 18,and 1.One month after the intervention treatment., grade A, B, C patients in the observation group was 22, 9, and 1,while the control group was 10,17, and 1.Nutritional status,Prior to the surgery, the numbers of hypoalbuminemia, hypokalemia, hyponatremia, and body mass index of the patients in observation group were 22,21,18, and 18.82±1.97, while the control group were 17,15,11, and 18.39±2.07. One month after the intervention treatment,observation group were 4,2,2, and 20.40±2.11, while the control group were 17,13,9, and16.87±1.90.Clinical symptoms, The color of feces, prior to the intervention treatment,numbers of yellow and clary colors in observation group were 11 and 21, while the control group were 15 and 13. One month after the intervention treatment,numbers of yellow and clary colors in observation group and control group were 29,3 and 17,11 respectively. The change in diet, observation group anorexia and normal were 25 and 7 in preoperative of intervention treatment, control group were 23 and 5, One month after the intervention treatment, observation group and control group were 4,28 and 19,9, Above indexs,comparation of preoperative and postoperative of observation group, the difference was statistically significant(P < 0.05), the control group, there was no statistically significant difference(P> 0.05),but the difference was statistically significant one month after the intervention treatment((P<0.05)).Itchy skin, prior to intervention treatment,numbers of the patients with itchy skin in observation and control group were 17 and 12.One month after the intervention treatment, numbers of the patients with itchy skin in observation and control group were 4 and 5.Compared the preoperative and postoperative data of observation group, the difference was statistically significant(P < 0.05). Two groups of patients with postoperative itchy skin were improved, preoperative and postoperative comparison of the two groups, the difference was statistically significant(P<0.05). The change in diet, observation group anorexia and normal were 25 and 7 in preoperative of intervention treatment, control group were 23 and 5, One month after the intervention treatment, observation group and control group were 4,28 and 19,9,Compared preoperative and postoperative of observation group, the difference was statistically significant(P < 0.05),the control group, there was no statistically significant difference(P> 0.05),but the difference was statistically significant one month after the intervention treatment(P< 0.05). The related complications after intervention treatment,Observation group 32 cases only with biliary drainage tube catheter pain 5 cases, bile leakage 3 cases, bile peritonitis 1 case, diarrhea 1 case, the control group were 6,3 and 2,there was no diarrhea.compared two groups, there was no statistically significant difference(P> 0.05).Conclusions: PTBD combined with the supplement extrinsicbile into the intestine is a simple, safe, and effective treatment of malignant obstructive jaundice.Compared with merely PTBD,there is a better curative effect.This strategy is beneficial to postoperative recoveries. Therefore, it was worthy of further optimization, promotion, and practice. |
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