目的 探讨肝门部胆管癌患者术前口服胆汁的效果与护理。 方法 我科 2012 年 8 月到 2014 年 1 月肝门部胆管癌 患者 80 例，均于术前行经皮肝穿刺胆汁外引流术（PTCD），按照剔除标准 7 例患者未纳入统计分析，行 PTCD 后第 5 天 根据是否口服胆汁，将病人分为 PTCD + 口服胆汁组（实验组， n=39）和单纯 PTCD 组（对照组， n=34）。分别于 PTCD 后 5、 8、 12 天清晨空腹抽血，检测血清肝功能及电解质 , 并记录 24 小时胆汁引流量、输液量、补钾量 , 记录患者主诉。采 用 χ2 检验、 t 检验及重复测量方法进行统计学分析。 结果 患者口服胆汁后：①食欲改善，实验组较对照组明显升高（PTCD 后第 8 天 P=0.009， PTCD 后第 12 天 P=0.001）。实验组口服胆汁后 10 例（10/39）出现轻度胃部不适， 3 例（3/39）出现 轻度腹胀，经过心理护理及口服方法调整后均能耐受；②实验组较对照组，总蛋白（P=0.017）及前白蛋白（P=0.019）显 著增高，总胆红素（P=0.989）下降无显著差异；③实验组较对照组输液量（P=0.017）与补钾量（P=0.011）均显著下降。 结论 与单纯 PTCD 相比， PTCD 联合口服胆汁，是肝门部胆管癌患者更好的一种术前准备方法。联合口服胆汁不仅减少了 患者的输液量、补钾量，而且显著改善了患者的营养状况。

Objective? ?To evaluate the effectiveness and nursing method of pre-operation oral bile in patient of hilar cholangiocarcinoma. Methods 80 patients’ clincal datum of hilar cholangiocarcinoma in Biliary Tract Surgery Dept 1 from August 2012 to January 2014 were collected, all of the patients accepted percutaneous transhepatic choledochus drainage (PTCD) before abdominal operation. According to exclusion criteria, 7 patients was not included in the analysis. According to oral bile or not, those patients were divided into two groups, the treatment group (PTCD+oral bile, n=39) and the control group (PTCD only, n=34). 5 days after PTCD, oral bile began in the treatment group. The serum test (liver function and electrolytes) was performed on day 5, day 8 and day 12 after PTCD. At the same time point, the bile ?ux, the transfusion volume, and the quantity of potassium supplement in 24 hours were recorded. The patients’ symptoms of anorexia or not were also recorded. χ2 test, t test and repeated measures were used to do the statistical analysis. Results After oral bile: (1)Appetite improvement rate, the treatment group increased signifcantly than the control group day 8 (P=0.009) and day 12 (P=0.001) after PTCD. In treatment group, 10 patients (10/39) had mild stomach discomfort, 3 patients (3/39) had mild distention. After psychological care and oral method of adjusting, the 13 patients tolerated the oral bile. (2) The serum total protein (P=0.017) and prealbumin (P=0.019) , the treatment group also increased signifcantly than the control group, while, the decrease rate of serum total bilirubin had no signifcant difference (P=0.989). (3)The transfusion volume (P=0.017) and supplement of potassium (P=0.011) the treatment group decreased signifcantly than the control group. Conclusions Compared with the only PTCD, PTCD combined with oral bile, was a kind of better method for pre-operation preparation in patient of hilar cholangiocarcinoma. PTCD combined with oral bile not only reduced the amount of transfusion and the supplement of potassium, but also signifcantly improved the nutritional situation of the patients.