| External biliary drainage is playing an important role in the treatment of obstructive jaundice.Patients with benign obstructive jaundice will perform external biliary drainage before surgery,which can improve the surgical safety rate.In patients with malignant obstructive jaundice,which is in the absence of radical surgery,it will alleviate the symptoms of jaundice,prolong the living time and improve the quality of life,as conservative treatment.Certainly,external biliary drainage also causes a series of complications,among which liver failure is the most serious.But,liver failure is often neglected because of its very low incidence.And,there are few reports at home and abroad.ObjectiveWe summarize the clinical features and therapeutic effect of patients with liver failure after external biliary drainage,to supplement the complications of external biliary drainage and to provide reference for clinical doctors to manage patients after external biliary drainage.MethodsA total of 165 cases of patients with obstructive jaundice were collected from the second department of hepatobiliary and pancreatic surgery,the first hospital of jilin university,between October 2015 and October 2017.There were 128 cases without hepatic failure after biliary external drainage,and 37 cases with hepatic failure after biliary externaldrainage.The study summarizes the patients’ age,gender,clinical diagnosis,drainage pattern,clinical features,and laboratory examination,applies SPSS22.0 statistical software to process the data,using statistical analysis of chi-square test,inspection standards a = 0.05.When P <0.05,difference was statistically significant.Then,Uses statistical analysis of F test in liver failure group,inspection standards a = 0.05.When P <0.05,difference was statistically significant,and use the line chart to illuminate the change trend of each index in each time period.Special treatment and prognosis were divided into 3 groups and were examined by chi-square test,and P<0.05 was considered statistically significant,and effective treatment was found.ResultThe proportion of liver failure patients with advanced age,high malignant obstruction,high bilirubin and high drainage volume was significantly higher.The changes of enzyme index were significant,and the overall trend was decreased,and the changes in liver failure stage were obvious,namely,the gamma-GT and ALP.Albumin decreased after drainage and obviously increased after treatment.Bilirubin decreased after drainage,did not decrease in liver failure,and decreased after special treatment.PTA was significantly decreased in liver failure,even<50%,but increased steadily after treatment,and the increase was slower and lower than the admission level.After the drainage,the potassiumdecreased significantly,and the ions were normal after the biliary re-transfusion.The PH goes up in the liver failure and is corrected to become normal.Blood ammonia increased significantly in liver failure and decreased after treatment.The liver failure is often associated with renal impairment;After treatment,it can be found that renal function index improves.The infection is severe in liver failure,and,Neutrophils increased significantly in hepatic failure and decreased significantly after treatment..Conclusion1 The patient’s age,high malignant obstruction,high bilirubin and high drainage volume may be the risk factors of liver failure after biliary drainage.2 In liver failure,the bilirubin did not decrease,and the ALT did not appear to rise significantly,and there are the imbalance of ion-acid-base balance,PTA decline and renal index increased.3 The effective treatment of liver failure after biliary drainage is mainly: change biliary drainage from external biliary drainage to internal biliary drainage,actively correct ion disorder and control infection... |
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