ERBD与PTBD在低位恶性梗阻性黄疸术前退黄中的应用比较

Comparison of ERBD and PTBD in the Preoperative Withdraw Jaundice Treatment of Low Malignant Obstructive Jaundice

目的:比较内镜逆行胆道引流术(ERBD)与经皮肝穿刺胆道引流术(PTBD)在低位恶性梗阻性黄疸术前退黄中的应用效果。方法:回顾性选取2019年5月-2021年5月在安阳市肿瘤医院行胰十二指肠切除术的60例低位恶性梗阻性黄疸患者,根据其术前不同引流退黄方式分为ERBD组(n=32)与PTBD组(n=28)。ERBD组采用ERBD退黄治疗,PTBD组采用PTBD退黄治疗。比较两组手术成功情况、血清学指标[总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)]水平、退黄时间、手术时间及术后并发症发生率。结果:ERBD组的手术成功率为96.88%,与PTBD组的89.29%比较,差异无统计学意义(P>0.05);两组手术时间比较,差异无统计学意义(P>0.05);ERBD组的退黄时间明显早于PTBD组(P<0.05);术后2周,两组血清TBIL、DBIL、ALT及AST水平均降低,且ERBD组低于PTBD组(P<0.05);术后,ERBD组的并发症总发生率为6.25%,明显低于PTBD组的25.00%(P<0.05)。结论:低位恶性梗阻性黄疸患者胰十二指肠切除术术前采取ERBD治疗的效果优于PTBD,且可降低术后并发症发生率。

Objective:To compare the effect of endoscopic retrograde biliary drainage(ERBD)and percutaneous transhepatic biliary drainage(PTBD)in the preoperative withdraw jaundice treatment of low malignant obstructive jaundice.Method:A total of 60 patients with low malignant obstructive jaundice who underwent pancreaticoduodenectomy in Anyang Cancer Hospital from May 2019 to May 2021 were retrospectively selected,and divided into ERBD group(n=32)and PTBD group(n=28)according to different ways of withdraw jaundice before operation.The ERBD group was treated with ERBD,and the PTBD group was treated with PTBD.The surgical success,serological indexes[total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)]levels,withdraw jaundice time,operation time and the incidence of postoperative complications were compared between the two groups.Result:The success rate of ERBD group was 96.88%,which was not significantly different from 89.29%in PTBD group(P>0.05).There was no significant difference in operation time between the two groups(P>0.05),but the withdraw jaundice time in ERBD group was significantly earlier than that in PTBD group(P<0.05).Two weeks after operation,the levels of serum TBIL,DBIL,ALT and AST in the two groups decreased,and the levels in ERBD group were lower than those in PTBD group(P<0.05).After operation,the total complication rate in ERBD group was 6.25%,which was significantly lower than 25.00%in PTBD group(P<0.05).Conclusion:The effect of ERBD before pancreaticoduodenectomy for patients with low malignant obstructive jaundice is better than that of PTBD,and the incidence of postoperative complications can be reduced.