探讨经皮经肝胆道引流术（PTCD）减黄联合胆汁回输在恶性梗阻性黄疸患者术前准备中的应用价值。

回顾性分析2006年5月至2015年6月在甘肃省人民医院行根治性手术的124例恶性梗阻性黄疸患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。根据术前采取的措施将患者分为减黄组和对照组。其中减黄组76例，男50例，女26例；平均年龄（54±3）岁；患者在常规术前准备基础上行PTCD减黄联合胆汁回输。对照组48例，男31例，女17例；平均年龄（56±3）岁；患者仅作常规术前准备。两组患者手术前后肝功能、胆道炎症指标变化及手术和术后情况比较采用t检验，率的比较采用χ²检验。

与入院时相比，减黄组患者术前1 d的ALT、AST、GGT、ALP、TB、C-反应蛋白明显下降（t= -14.19，-18.47，-31.99，-22.86，-24.69，-20.47；P<0.05）。术后7 d减黄组的ALT、AST、TB及PT较对照组明显下降（t= -8.59，-17.79，-21.76，-8.75；P<0.05），ALB较对照组明显升高（t=10.41，P<0.05）。减黄组行胆肠吻合术、胰十二指肠切除术的手术时间分别为（98±14）、（204±21）min，明显短于对照组的（116±14）、（248±25）min（t= -6.97，-10.55；P<0.05）。减黄组行胆肠吻合术、胰十二指肠切除术的术中出血量分别为（115±11）、（224±24）ml，明显少于对照组的（151±16）、（312±30）ml（t= -14.85，-18.03；P<0.05）。减黄组的术后住院时间为（13±3）d，明显短于对照组的（19±3）d（t= -10.85，P<0.05）。

对于恶性梗阻性黄疸患者，术前PTCD联合胆汁回输有利于提高患者对根治性手术的耐受性，减少术中出血量，缩短手术时间，并促进术后肝功能恢复，从而提高手术疗效。

To explore the application value of percutaneous transhepatic cholangiodrainage (PTCD) combined with bile transfusion in the preoperative preparation for patients with malignant obstructive jaundice.

Clinical data of 124 patients with malignant obstructive jaundice underwent radical surgery in Gansu Provincial Hospital between May 2006 and June 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into the biliary drainage group (n=76) and control group (n=48) according to the preoperative treatments. In the biliary drainage group, 50 males and 26 females, aged (54±3) years old on average, underwent PTCD combined with bile transfusion on the basis of routine preoperative preparation. In the control group, 31 males and 17 females, aged (56±3) years old on average, received routine preoperative preparation alone. Preoperative and postoperative liver function, biliary tract inflammation indexes, intraoperative and postoperative situation in two groups were compared using t test. And the rate was compared using Chi-square test.

Compared with the indexes on admission, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin (TB) and C-reactive protein in the biliary drainage group at 1 d before operation significantly declined (t=-14.19, -18.47, -31.99, -22.86, -24.69, -20.47; P<0.05). Compared with those in the control group, the levels of ALT, AST, TB and PT in the biliary drainage group at postoperative 7 d significantly declined (t=-8.59, -17.79, -21.76, -8.75; P<0.05), whereas the level of ALB significantly increased (t=10.41, P<0.05). The operation time of cholecystojejunostomy and pancreaticoduodenectomy in the biliary drainage group was respectively (98±14) and (204±21) min, significantly shorter than (116±14) and (248±25) min in the control group (t=-6.97, -10.55; P<0.05). The intraoperative blood loss of cholecystojejunostomy and pancreaticoduodenectomy in the biliary drainage group was respectively (115±11) and (224±24) ml, significantly lower than (151±16) and (312±30) ml in the control group (t=-14.85, -18.03; P<0.05). The postoperative length of hospital stay in the biliary drainage group was (13±3) d, significantly shorter than (19±3) d in the control group (t=-10.85, P<0.05).

For patients with malignant obstructive jaundice, preoperative PTCD combined with bile transfusion help to enhance the patients' tolerance to the radical surgery, reduce the intraoperative blood loss, shorten operation time and accelerate postoperative recovery of liver function, thereby improving the effect of operation.