| 席江伟,王艳,刘斌,等.PTCD应用自制胆汁回输器行胆汁回输、肠内营养支持的临床价值[J].安徽医药,2025,29(4):743-747. |
| PTCD应用自制胆汁回输器行胆汁回输、肠内营养支持的临床价值 |
| Clinical value of PTCD with homemade bile reinfusion and enteral nutrition support |
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| DOI：10.3969/j.issn.1009-6469.2025.04.022 |
| 中文关键词: 黄疸，阻塞性 肠道营养 经皮经肝胆管穿刺引流 胆汁回输器 双腔空肠营养管 胆汁回输 |
| 英文关键词: Jaundice, obstructive Enteral nutrition Percutaneous transhepatic cholangial drainage Bile reinfusion device Double lumen jejunal nutrition tube Bile reinfusion |
| 基金项目:张家口市科技研发计划项目( 2121093D) |
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| 中文摘要: |
| 目的探究晚期恶性梗阻性黄疸病人经皮经肝胆管穿刺引流( percutaneous transhepatic cholangial drainage，PTCD)应用自制胆汁回输器、双腔空肠营养管行胆汁回输、肠内营养支持的临床价值。方法回顾性选取 2019年 1月至 2022年 1月河北北方学院附属第二医院收治的晚期恶性梗阻性黄疸病人，按照引流方式的不同分为 A组( n=25，PTCD与空肠营养管体外对接)B组( n=25，PTCD与自制胆汁回输器行胆汁回输与空肠营养液同时或间断进入空肠)，C组( n=25，PTCD自体胆汁间断定时回，输联合肠内营养)；同时选取对照组( n=25，PTCD引流出体外胆汁丢弃；四组均同时给予肠内营养支持进行治疗。采用干式全自动生化分析仪检测谷草转氨酶( AST)、碱性磷酸酶( ALP)、总胆红素( TBiL)和直接胆红素( DBiL)的水平；采用西门子全自动生化分析仪检测白蛋白、前白蛋白( PA)的水平；使用微型营养评估( MNA)量表对所有病人进行评分。结果 A、B、C组和对照组的 AST［( 104.72±8.13)U/L、(97.61±7.96)U/L、(106.56±8.25)U/L、(114.52±8.47)U/L］、 ALP［( 331.46±17.67)U/L、(317.15±16.83)U/L、(333.54±18.01)U/L(342.96±18.74)U/L］、 TBiL、DBiL水平在治疗后与治疗前比较均显著降低［( 132.18±11.24)U/L、(131.53±10.87)U/L、(130.73±10.62)U/L、(129.46±10.15)U/L；(403.37±25.51)U/L、(401.76±25.35)U/L、(398.72±24.87)U/L、(395.94±24.63)U/L］(P<0.05)；治疗后 A、B、C组的 AST、ALP、TBiL、DBiL水平均显著低于对照组且 B组显著低于 A、C组( P<0.05)； A、B、C组和对照组的白蛋白、 PA水平在治疗后均显著升高( P<0.05)；治疗后 A、B、C组的白蛋白、 PA水平均显著高于对照组且 B组显著高于 A、C组( P<0.05)； A、B、C组和对照组的 MNA评分在治疗后均显著升高( P<0.05)；治疗后 A、B、C组的 MNA评分均显著高于对照组且 B组显著高于 A、C组( P<0.05)。结论 PTCD后使用自制胆汁回输器将引流收集的胆汁与空肠营养液同时或间断输入空肠治疗更有助于晚期恶性梗阻性黄疸病人术后肝功能的恢复，改善病人的营养状态。 |
| 英文摘要: |
| Objective To explore the clinical value of self-made bile reinfusion device and double-lumen jejunal nutrition tube forbile reinfusion and enteral nutrition support in the percutaneous transhepatic cholangial drainage (PTCD) for patients with advancedmalignant obstructive jaundice. Methods Patients with advanced malignant obstructive jaundice admitted to The Second Affiliated Hospital of Hebei North University from January 2019 to January 2022 were retrospectively selected and divided into group A (n=25): PTCD and jejunal nutrition tube in vitro docking, group B (n=25): PTCD and homemade bile reinfusion into the jejunum at the same time or intermittently, group C (n=25): PTCD intermittent autologous bile infusion combined with enteral nutrition; At the same time, the control group (n=25) was selected to discard the bile :PTCD drained out of the body, and enteral nutrition support was given fortreatment.The levels of aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBiL) and direct bilirubin (DBiL)were detected by dry automatic biochemical analyzer. Siemens automatic biochemical analyzer was used to detect the levels of albumin(ALB) and prealbumin (PA). All patients were scored using a mini-nutrient assessment scale (MNA).Results In groups A, B, C andcontrol group, AST[(104.72±8.13) U/L, (97.61±7.96) U/L, (106.56±8.25) U/L, (114.52±8.47) U/L], ALP [(331.46±17.67) U/L, (317.15±16.83) U/L, (333.54± 18.01) U/L, (342.96±18.74) U/L], TBiL, DBiL levels were significantly reduced after treatment compared withpre-treatment [(132.18±11.24) U/L, (131.53±10.87) U/L, ( 130.73±10.62) U/L, (129.46±10.15) U/L; (403.37±25.51) U/L, (401.76±25.35) U/L, (398.72±24.87) U/L, (395.94±24.63) U/L](P<0.05); AST, ALP, TBiL and DBiL levels in groups A, B and C were signifi. cantly lower than those in the control group and group B was significantly lower than groups A and C after treatment (P<0.05); albumin and PA levels in groups A, B, C and the control group were significantly higher after treatment (P<0.05). The levels of albumin and PAin groups A, B and C were significantly higher than those in the control group and group B was significantly higher than groups A and C(P < 0.05); the MNA scores of groups A, B and C and the control group were significantly higher after treatment (P < 0.05); the MNAscores of groups A, B and C were significantly higher than those of the control group and group B was significantly higher than those ofgroups A and C after treatment (P<0.05).Conclusion After PTCD, the use of self-made bile return device to inject the collected bileand jejunal nutrient solution into jejunum at the same time or discontinuously can help the recovery of liver function and improve thenutritional status of patients with advanced malignant obstructive jaundice. |
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