ERCP与PTCD姑息治疗恶性梗阻性黄疸的疗效对比  

ERCP and PTCD palliative treatment of malignant obstructive jaundice

作　　者：杨春建 胡钢 潘升权 胡开兵 殷世武 YANG Chun-jian;HU Gang;PAIN Sheng-quan(The Second People's Hospital of Hefei,Hefei 230011,China)

机构地区：[1]安徽医科大学附属合肥医院,合肥市第二人民医院普外科,合肥230011

出　　处：《肝胆外科杂志》2023年第2期126-130,共5页Journal of Hepatobiliary Surgery

摘　　要：目的探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)和经皮肝穿刺胆道引流(percutaneous transhepatic choledochus drainage,PTCD)在恶性梗阻性黄疸中的临床疗效。方法回顾性分析2015~~2021年合肥市第二人民医院收治的50例恶性胆道梗阻患者临床资料,其中男29例,女21例;年龄40~92岁。依据患者胆道引流方式的不同,分为两组:ERCP组24例,均采用ERCP方式引流;PTCD组26例,均采用PTCD方式引流。比较分析两组患者的临床疗效、术后并发症、术后住院时间、住院费用等指标。结果PTCD组和ERCP组患者术前的血清TBIL、DBIL、ALT、GGT、ALP水平差异均无统计学意义(P>0.05);术后1w两组患者的上述生化指标均较术前有显著下降,手术前后差异有统计学意义(P<0.05),但术后两组之间上述指标的对比差异无统计学意义(P>0.05)。术后1w,ERCP组的低位恶性梗阻患者TBIL水平缓解效果优于PTCD组,而该组高位恶性梗阻患者的TBIL水平缓解效果则明显差于PTCD组,差异有统计学意义(P<0.05)。ERCP组术后并发症发生率:胰腺炎(10/24)41.7%、胆道感染(9/24)37.5%、出血(2/24)8.33%,无死亡、穿孔及支架移位;PTCD组术后并发症发生率:胰腺炎(1/24)3.85%、胆道感染(14/26)53.8%、出血(2/26)7.7%、死亡(1/26)3.85%、支架移位(1/24)3.85%,无穿孔;两组胰腺炎的发生率差异有统计学意义(P<0.05)。ERCP组和PTCD组住院时间分别为(19.5±8.3)和(22.3±10.5)d,差异无统计学意义(P>0.05),住院费用分别为(4.11±1.40)和(4.11±1.78)万元,差异无统计学意义(P>0.05)。结论ERCP和PTCD治疗恶性梗阻性黄疸均可获得满意的临床疗效,其中ERCP在低位梗阻中效果更优,而PTCD在高位梗阻中效果更优。对于不同部位的恶性梗阻性黄疸,应结合患者具体情况进行合理选择。Objective To investigate the clinical effect of endoscopic retrograde cholangiopancreatography(endoscopic retro-grade cholangiopancreatography,ERCP)and percutaneous hepatic puncture drainage(percutaneous transhepatic choledochus drainage,PTCD)in malignant obstructive jaundice.Methods The clinical data of 50 patients with malignant biliary obstruction admitted to Hefei Second Peoples Hospital in 2015~2021 were analyzed retrospectively,including male 29 cases,21 women;age 40~92 years.The patients were divided into two groups according to the different drainage methods of biliary tract:ERCP group 24 cases,all used ERCP drainage;PTCD group 26 cases,all used PTCD drainage.Compare and analyze the clinical efficacy,postoperative complica-tions,postoperative hospitalization time,hospitalization expenses and other indicators of the two groups.Results There was no signif-icant difference in serum TBIL、DBIL ALT、GCT、ALP level between the PTCD group and the ERCP group(P>0.05).health,the difference before and after operation was statistically significant(P<0.05),but there was no significant difference between the above indexes between the two groups after operation(P>0.05).The TBIL level relief effect of w,ERCP group was better than that of the PTCD group,but the TBIL level relief effect of the group was significantly worse than that of the PTCD group(0.05).incidence of postoperative complications in group ERCP:pancreatitis(10/24)41.7%,biliary tract infection(9/24)37.5%,hemorrhage(2/24)8.33 The incidence of postoperative complications in PTCD groups was 3.85%,53.8%,7.7%,3.85%,1/26,3.85%and 3.85%re-spectively.The incidence of pancreatitis in the two groups was statistically significant(P<0.05).ERCP and PTCD groups were(19.5±8.3)and(22.3±10.5)respectively.There was no significant diference(P>0.05).There was no significant difference between4.11±1.40)and(4.11±1.78)million yuan(P>0.05).Conclusion ERCP and PTCD treatment of malignant obstruc-tive jaundice can obtain eatisfactory clinical eficacy,among which ERCP io bcttcr

关 键 词：ERCP PTCD 梗阻性黄疽 胰胆管造影 胆道引流 

分 类 号：R730.5[医药卫生—肿瘤]