ERBD与PTBD在肝门胆管癌术前减黄中的应用比较

Comparison of ERBD and PTBD in Preoperative Yellow Reduction of Hilar Cholangiocarcinoma

目的:探讨肝门胆管癌梗阻性黄疸术前减黄使用内镜逆行胆道引流术(ERBD)与经皮肝穿刺胆道引流术(PTBD)的效果。方法:收集上海市徐汇区中心医院在2021年1月—2023年12月确诊为肝门胆管癌并行术前减黄治疗的低位恶性梗阻性黄疸患者158例,依据术前减黄方案不同划分为两个组别,即ERBD组,患者78例,接受内镜逆行胆道引流术;PTBD组,患者80例,接受经皮肝穿刺胆道引流术。比较两组手术成功率;比较两组疗效有效率(引流成功率);比较术前术后血清学指标[谷氨酰转移酶(GGT)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、天冬氨酸氨基转移酶(AST)]水平;比较术后并发症情况。结果:ERBD组与PTBD组的手术成功率、疗效有效率(引流成功率)、术后并发症总发生率比较,无统计学差异(P>0.05)。两组血清GGT、ALT、ALP、AST水平术后均较术前下降(P<0.05);但两组术后血清GGT、ALT、ALP、AST水平比较,无统计学差异(P>0.05)。ERBD组术后疼痛发生率较PTBD组低,术后胆道感染发生率较PTBD组高(P<0.05)。结论:肝门部胆管癌梗阻性黄疸患者术前采取ERBD、PTBD减黄治疗在手术成功率、减黄效果上比较无差异,但术后胆道感染与疼痛各有优势,可依据患者具体情况、胆道解剖结构等综合考虑,选择最为合适的胆道引流技术。

Objective:To explore the porta hepatis bile duct carcinoma obstructive jaundice yellow preoperative reduction using endoscopic retrograde biliary drainage(ERBD),liver puncture percutaneous biliary drainage(PTBD)effect.Methods:A total of 158 patients with low malignant obstructive jaundice diagnosed with hilar cholangiocarcinoma and accompanied by preoperative deconyelination were collected from Shanghai Xuhui District Central Hospital from January 2021 to December 2023.They were divided into two groups according to different preoperative deconyelination programs,namely ERBD group,78 patients received endoscopic retrograde biliary drainage.PTBD group,80 patients,received percutaneous transhepatic biliary drainage.Compare two groups of operation success rate;Compare two groups of curative effect of efficient(drainage rate);Comparing preoperative postoperative serological index[glutamine transferase(GGT),alanine aminotransferase(ALT),alkaline phosphatase(ALP),aspartate aminotransferase(AST)]level;Postoperative complications were compared.Results:There was no significant difference between ERBD group and PTBD group in surgical success rate,effective rate(successful rate of drainage)and total incidence of postoperative complications(P>0.05).The levels of serum GGT,ALT,ALP and AST in both groups were decreased after operation compared with those before operation(P<0.05).However,there were no significant differences in serum GGT,ALT,ALP and AST levels between the two groups(P>0.05).The incidence of postoperative pain in ERBD group was lower than that in PTBD group,and the incidence of postoperative biliary tract infection was higher than that in PTBD group(P<0.05).Conclusion:In patients with obstructive jaundice of hilar cholangiocarcinoma,there is no difference in the success rate and yellowed effect of preoperative ERBD and PTBD treatment,but postoperative biliary tract infection and pain have their own advantages.The most appropriate biliary drainage technique can be selected according to the specific conditions of patients and the anatomical structure of biliary tract.