经内镜逆行胰胆管造影术与经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的比较  

Clinical analysis of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage for treatment of malignant obstructive jaundice

作　　者：张小坚[1] 张联合[1] 张士良[1] 李东燕[1] 

机构地区：[1]武警浙江省总队杭州医院放射科,浙江杭州310057

出　　处：《中华全科医学》2016年第4期575-577,共3页Chinese Journal of General Practice

摘　　要：目的探讨经内镜逆行胰胆管造影术(ERCP)与经皮肝穿刺胆道引流术(PTCD)治疗恶性梗阻性黄疸的临床效果,为临床选择术式提供参考。方法选择140例恶性梗阻性黄疸患者,按照治疗术式分为ERCP组与PTCD组。对比2组患者手术成功率、黄疸缓解率、并发症、治疗成本及相关临床指标。结果 ERCP组与PTCD组低位梗阻及高位梗阻手术成功率分别为94.74%vs.71.43%、84.21%vs.100.00%,对比差异均有统计学意义(P<0.05);ERCP组与PTCD组低位梗阻及高位梗阻黄疸缓解率分别为98.25%vs.78.57%、68.42%vs.92.00%,对比差异均有统计学意义(P<0.05);两组ALT、DBIL、TBIL术后2周与术前均有明显改善,对比差异有统计学意义(P<0.05);ERCP组与PTCD组,整体并发症发生率为5.26%vs.17.19%,对比差异有统计学意义(P<0.05),ERCP组与PTCD组低位梗阻黄疸并发症发生率分别为1.75%vs.28.57%,对比差异有统计学意义(P<0.05);ERCP组与PTCD组住院时间、手术费用、治疗费用分别为(13.54±2.54)d vs.(20.14±3.38)d、(2.62±0.15)万元vs.(2.15±0.41)万元、(4.82±0.69)万元vs.(5.04±0.71)万元,住院时间、手术费用对比差异有统计学意义(P<0.05)。结论 ERCP与PTCD治疗恶性梗阻性黄疸均可以取得较好的临床效果,低位梗阻首选ERCP治疗,高位梗阻首选PTCD治疗。Objective To investigate clinical effect of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage for treatment of malignant obstructive jaundice,to provide a reference for clinical treatment.Methods One hundred and forty cases of malignant obstructive jaundice patients were selected,divided into ERCP group and PTCD group according to the surgical treatment. The surgical success rate,jaundice remission rate,complications,treatment costs and clinical indicators were compared. Results In ERCP group and PTCD group,the low obstruction and high obstruction success rates were 94. 74% vs. 71. 43%,84. 21% vs. 100. 00%,the differences were statistically significant（ P〈0. 05）; the low and high obstruction obstructive jaundice remission rates were 98. 25% vs. 78. 57%,68. 42% vs. 92. 00%,the differences were statistically significant（ P〈0. 05）; after two weeks,two groups of patients were significantly improved. The difference was statistically significant（ P〈0. 05）. In ERCP group and PTCD group,the overall complication rate was 5. 26% vs 17. 19%,contrast significantly（ P〈0. 05）,in ERCP group and PTCD group with low obstruction complication rates were 1. 75 % vs. 28. 57%,the differences were statistically significant（ P〈0. 05）;in ERCP group and PTCD group,length of stay,cost of surgery,treatment cost were（13. 54 ± 2. 54） d vs.（20. 14 ± 3. 38）d,（2. 62 ± 0. 15） × 10 000 Yuan vs（2. 15 ± 0. 41） × 10 000 Yuan,（4. 82 ± 0. 69） vs.（5. 04 ± 0. 71） × 10 000 Yuan,the difference was statistically significant（ P〈0. 05）. Conclusion ERCP and PTCD treatment both has good effect for malignant obstructive jaundice,for low obstruction ERCP treatment should be preferred,for high obstruction PTCD treatment should be preferred.

关 键 词：经内镜逆行胰胆管造影术 经皮肝穿刺胆道引流术 恶性梗阻性黄疸 

分 类 号：R657.43[医药卫生—外科学]