梗阻性黄疸术前不同减黄方式对疗效的影响分析

Analysis of the effect of different ways of reducing jaundice before operation on the curative effect of obstructive jaundice

目的研究梗阻性黄疸术前不同减黄方式对疗效的影响,为临床选择合适的术式给予一定的参考价值。方法选取本院2016年10月~2019年3月收治的梗阻性黄疸患者为研究对象,共143例。依据患者的自身状况以及自愿原则,将患者分为不同的术式,分为ERCP组(78例)和PTCD组(65例)。ERCP组给予内镜逆行胰胆管造影术(ERCP)治疗,PTCD组给予经皮肝穿刺胆道引流术(PTCD)治疗。比较两组手术成功率、并发症发生率、舒适度评分以及术后5 d血清总胆红素水平。结果治疗良性梗阻性黄疸时,两组手术成功率相比(90.0%vs 81.3%),差异无统计学意义,P>0.05;ERCP组术后并发症发生率低于PTCD组(5.0%vs 28.1%),P<0.05;术后5 d血清总胆红素水平下降值对比(97.5±11.3)μmol/L vs(81.8±12.5)μmol/L差异有统计学意义(P<0.05)。在治疗恶性梗阻性黄疸时,两组手术成功率对比(63.2%vs 84.8%)差异有统计学意义(P<0.05);两组并发症发生率相比(15.8%vs 12.1%),差异无统计学意义(P>0.05);术后5 d血清总胆红素下降值对比[(186.3±18.6)μmol/L vs(207.8±20.9)μmol/L]差异有统计学意义(P<0.05);ERCP组和PTCD组术后舒适度量表评分对比[(16.7±3.4)分vs.(18.1±3.8)分],差异有统计学意义(P<0.05。结论ERCP和PTCD治疗梗阻性黄疸均获得了满意的临床效果,患者可依据其自身状况,选择合适的术式,以此改善梗阻症状,提高临床临床疗效。

Objective To study the effect of different ways of reducing jaundice before obstructive jaundice on the curative effect,and to give a certain reference value for clinical selection of appropriate surgical procedures.Methods A total of 143 patients with obstructive jaundice admitted to our hospital from October 2016 to March 2019 were enrolled.According to the patient’s own condition and voluntary principle,the patients were divided into different surgical procedures,which were divided into ERCP group and PTCD group.The ERCP group(78 patients)received endoscopic retrograde cholangiopancreatography(ERCP),while the PTCD group(65 patients)received percutaneous transhepatic biliary drainage(PTCD).The success rate,complication rate,comfort score and serum total bilirubin level of ERCP group and PTCD group were compared to evaluate the effect of different methods of reducing yellowing on curative effect.Results In the treatment of benign obstructive jaundice,the postoperative complications of ERCP and PTCD were 5.0%vs.28.1%,respectively,and the serum total bilirubin levels decreased by(97.5±11.3)μmol vs.(81.8±12.5)μmol/L at 5 days postoperatively,the difference was statistically significant(P<0.05);there was no significant difference in the success rate between the two groups(P>0.05).In the treatment of malignant obstructive jaundice,the success rate of ERCP group and PTCD was 63.2%vs.84.8%,and the serum total bilirubin decreased by(186.3±18.6)μmol/L vs.(207.8±20.9)μmol/L,the difference was statistically significant(P<0.05);and the difference in complication rate between the two groups was not statistically significant(P>0.05).The postoperative comfort scores of the ERCP and PTCD groups were(16.7±3.4)vs.(18.1±3.8),and the difference was statistically significant(P<0.05).Conclusion ERCP and PTCD have achieved good clinical efficacy in the treatment of benign and malignant obstructive jaundice.They all have their advantages.Patients can choose appropriate treatment according to their actual conditions to improve the symptoms of obstruction and improve clinical clinical efficacy.