| 张雪松,宋 磊,王魁阳.药物干预降低恶性梗阻性黄疸行PTCD术后急性胰腺炎40例临床分析[J].中国肿瘤,2014,23(4):352-355. |
| 药物干预降低恶性梗阻性黄疸行PTCD术后急性胰腺炎40例临床分析 |
| Clinical Analysis of Drug Interventions to Reduce the Occurrence of Acute Pancreatitis after PTCD in 40 Cases with Malignant Obstructive Jaundice |
| 投稿时间：2013-12-05 |
| DOI：10.11735/j.issn.1004-0242.2014.04.A018 |
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| 中文关键词: 经皮肝胆道穿刺引流术 梗阻性黄疸 急性胰腺炎 |
| 英文关键词:percutaneous transhepatic cholangial drainage obstructive jaundice acute pancreatitis |
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| 中文摘要: |
| 摘 要：［目的］分析恶性梗阻性黄疸患者行PTCD前后应用药物进行预处理以减少术后急性胰腺炎的发生。［方法］对40例高龄、低位恶性肿瘤所致梗阻性黄疸患者，行DSA引导下PTCD胆道支架植入及肝外引流管植入治疗。分为对照组及药物预处理组，每组20例。对照组术前、术后不行预防性用药；药物预处理组患者术前1h预防性皮下注射醋酸奥曲肽0.1mg，术后继续皮下注射醋酸奥曲肽0.1 mg，每8h 1次，连续3d。分别于术前、术后24h、48h及72h观察两组患者症状体征，复查血、尿淀粉酶及胰腺CT情况。［结果］ 72h内药物预处理组与对照组恶心呕吐情况无差异（P＞0.05）；腹痛及腹膜炎情况药物预处理组轻于对照组（P＜0.05）；血淀粉酶升高例数药物预处理组明显多于对照组（P＜0.01）；尿淀粉酶升高例数药物预处理组明显多于对照组（P＜0.05）；术后72h内腹部CT阳性例数药物预处理组6例、对照组1例（P＜0.05）；药物预处理组术后确诊胰腺炎1例，对照组7例（P＜0.05）。［结论］针对高龄、低位恶性梗阻性黄疸患者行PTCD治疗时，可于术前及术后预防性应用醋酸奥曲肽，以减少术后发生急性胰腺炎概率或减轻术后急性胰腺炎病情程度，有利于患者术后恢复。 |
| 英文摘要: |
| Abstract：［Purpose］ Analysis of the incidence of postoperative acute pancreatitis via drug pretreatment before or after PTCD. ［Methods］ Fourty elderly cases with low-set malignant obstructive jaundice underwent biliary tract stents implanted and extrahepatic drainage ductus through PTCD under DSA guidance were enrolled. The cases were divided into control group and treatment group(n=20). The control group was no medication preoperation and postoperation， the treatment group was subcutaneous injected with 0.1mg octreotide acetate at 1 hour before surgery and every 8 hours postoperation for 3 days. Hemogram and amylase in urine were measured before sugery and at 24h，48h and 72h after surgery were detected.［Results］ The happening of nausea and vomiting had no significant difference between the two groups(P>0.05)，however the patients with symptoms and signs of peritonitis was milder in treatment group than those in control group (P<0.05). The number of cases with increased amylase in pretreatment group was less than those in control group(P<0.01). There were 6 cases with positive finding by CT scan within 72h after surgery in control group while only 1 case in pretreatment group with statistical significance(P<0.05).［Conclusion］ For elderly patients with low-set malignant obstructive jaundice，octreotide acetate administration preoperation and postoperation could reduce the incidence of acute pancreatitis or relieve the somptom of acute pancreatitis. |
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