不同姑息性引流术对低位恶性梗阻性黄疸的近远期疗效及安全性分析  

Analysis of the short-term and long-term efficacy and safety of different palliative drainage procedures on low malignant obstructive jaundice

作　　者：王玮 陈熙[1] 罗丹[1] 李启祥[1] 尹合坤[1] WANG Wei;CHEN Xi;LUO Dan;LI Qixiang;YIN Hekun(Department of Gastroenterology,Jiangmen Central Hospital,Jiangmen,Guangdong,529030,China)

机构地区：[1]江门市中心医院消化内科,广东江门529030

出　　处：《当代医学》2022年第19期39-42,共4页Contemporary Medicine

基　　金：2021度年江门市科技计划项目(2021YL01024)。

摘　　要：目的 探讨不同姑息性引流术对低位恶性梗阻性黄疸的近远期疗效及安全性。方法 选取2016年9月至2019年5月本院收治的240例低位恶性梗阻性黄疸患者作为研究对象,根据手术方案的不同分为对照组和内镜逆行胆胰管造影(ERCP)组,每组120例。对照组行经皮肝穿刺胆管引流术(PTCD),ERCP组行ERCP支架植入胆道引流术,比较两组手术情况、减黄程度、免疫功能、术后并发症及远期疗效。结果 术后,ERCP组住院时间短于对照组,住院费用低于对照组(P<0.05);术后,两组血清总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)及总胆汁酸(TBA)水平、可溶性白细胞介素-2受体(sIL-2R)及脂多糖(LPS)水平均明显低于术前,且ERCP组明显低于对照组(P<0.05);两组并发症发生率比较差异无统计学意义;ERCP组1年生存率明显高于对照组(P<0.05)。结论 相较于PTCD,ERCP支架植入胆道引流术治疗低位恶性梗阻性黄疸患者疗效更显著,能有效提高患者免疫功能,缩短住院时间,减少住院费用,提高远期生存率。Objective To explore the short-term and long-term efficacy and safety of different palliative drainage procedures on low malignant obstructive jaundice. Methods 240 patients with low-level malignant obstructive jaundice who were admitted to our hospital from September 2016to May 2019 were selected as the research subjects and they were divided into the control group and the endoscopic retrograde cholangiopancreatography(ERCP) group according to the different surgical plan, with 120 cases in each group. The control group underwent percutaneous transhepatic cholangic drainage(PTCD), and the ERCP group underwent ERCP with stentting for biliary drainage. The operation status, recovery of jaundice, immune function, postoperative complications and long-term effect were compared between the two groups. Results After the operation, the hospitalization time of the ERCP group was shorter than that of control group, the hospitalization cost of the ERCP group were lower than that of control group(P<0.05). After operation, the postoperative levels of total serum bilirubin(TBIL), direct bilirubin(DBIL), and alanine aminotransferases(ALT) and total bile acid(TBA), the postoperative levels of serum soluble interleukin-2 receptor(sIL-2R) and lipopolysaccharide(LPS) were significantly lower than those before operation, and the ERCP group was significantly lower than that of control group(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups. The 1-year survival of ERCP group was significantly higher than that of the control group(P<0.05). Conclusion Compared with PTCD, ERCP stent implantation with biliary drainage is more effective in the treatment of patients with low malignant obstructive jaundice, which can effectively improve the patient’ s immune function, shorten hospitalization time,reduce hospitalization costs, and improve long-term survival rate.

关 键 词：低位恶性梗阻性黄疸 内镜逆行胆胰管造影术 经皮肝穿刺胆管引流术 

分 类 号：R735[医药卫生—肿瘤]