Clinical efficacy and safety of ultrasound-guided percutaneous transhepatic cholangic drainage in treatment of malignant obstructive jaundice patients
Objective To investigate the clinical efficacy of ultrasound-guided percutaneous transhepatic cholangic drainage(PTCD)in the treatment of malignant obstructive jaundice(MOJ)and its effects on traumatic stress response,liver function and coagulation function.Methods Totally 124 patients with MOJ in the Puyang Oilfield General Hospi-tal from January 2021 to December 2022 were selected and divided into conventional PTCD group(n=62)and ultra-sound-guided PTCD group(n=62).Ultrasound-guided PTCD group underwent PTCD operation under ultrasound guidance.The conventional PTCD group underwent PTCD surgery under the guidance of conventional X-ray.The clini-cal efficacy of the two groups was compared by rank-sum test,surgical indexes of the two groups was compared by inde-pendent sample t test,traumatic stress indexes[serum cortisol(Cor),norepinephrine(NE)and hypersensitive C-reactive protein(hs-CRP)],liver function indexes[serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBil),direct bilirubin(DBil)]and coagulation function indexes[prothrombin time(PT)and activated thrombin time(APTT)]at different time points before and after surgery were compared by paired sample t test,and complications of the two groups were compared by Chi-square test.Results After 2 weeks of operation,the total clinical effective rate of Ultrasound-guided PTCD group was 90.32％,which was slightly higher than that of con-ventional PTCD group 83.87％,but there was no significant difference(P＞0.05).The operation time of ultrasound-guided PTCD group was significantly shorter than that of conventional PTCD group,and the success rate of one-time puncture(95.16％)was significantly higher than that of conventional PTCD group(59.68％)(P＜0.05).After 3 days and 1 weeks of operation,serum levels of Cor,NE and hs-CRP in both groups presented a trend of first increase and then decrease,and the fluctuation range of serum levels of Cor,NE and hs-CRP in ultrasound-guided PTCD group was lower than that in conventional PTCD group(P＜0.05).After 1 week of operation,the levels of ALT,AST,TBil and DBil in the ultrasound-guided PTCD group were significantly lower than those in the conventional PTCD group,while the levels of PT and APTT were significantly higher than those in the conventional PTCD group(P＜0.05).Conclusion Both ultrasound-guided PTCD surgery and conventional X-ray PTCD surgery have good clinical effica-cy,but ultrasound-guided PTCD surgery takes a shorter time,has a higher success rate and surgical safety,and can fur-ther reduce the traumatic stress reaction of surgery,improve the liver function and coagulation function of patients,and contribute to rapid postoperative recovery.
Malignant obstructive jaundicePercutaneous transhepatic cholangic drainageUltrasonic guidanceStress responseLiver functionCoagulation function
NETL
NSTL
万方数据
