两种不同途径胆道金属支架植入治疗恶性阻塞性黄疸的对比研究

Implantation of biliary metallic stent for malignant obstructive jaundice: technical comparison study between via ERCP route and via PTCD route

目的比较经内镜逆行胰胆管造影术(ERCP)途径与经皮肝胆管引流术(PTCD)途径胆道金属支架植入治疗恶性阻塞性黄疸(MOJ)的临床效果。方法选取2010年6月—2015年6月行胆道金属支架植入治疗的MOJ患者136例,其中经ERCP途径53例(ERCP组),经PTCD途径83例(PTCD组)。比较两组的手术成功率、有效率、术后并发症发生率、住院时间及手术费用。结果 (1)低位梗阻中ERCP组和PTCD组的手术成功率分别为97.7%和95.8%,差异无统计学意义(P>0.05);高位梗阻中ERCP组的手术成功率明显低于PTCD组(77.8%和98.3%),差异有统计学意义(P<0.05);(2)ERCP组和PTCD组总有效率分别为(88.7%和90.3%),差异无统计学意义(P>0.05);低位梗阻中ERCP组有效率明显高于PTCD组(93.2%和83.3%),差异有统计学意义(P<0.05);高位梗阻中ERCP组有效率明显低于PTCD组(66.7%和93.2%),差异有统计学意义(P<0.05);(3)ERCP组总并发症发生率明显低于PTCD组(7.5%和15.7%),差异有统计学意义(P<0.05);低位梗阻中和ERCP组并发症发生率低于PTCD组(4.5%和29.2%),差异有统计学意义(P<0.05);高位梗阻中ERCP组并发症发生率明显高于PTCD组(22.2%和10.2%),差异有统计学意义(P<0.05);(4)ERCP组和PTCD组住院时间分别为(13.67±2.25)d和(19.75±3.78)d,差异有统计学意义(P<0.05);ERCP组PTCD组的手术花费分别为(23 764.23±2 437.76)元和(24 863.45±2 983.37)元,差异无统计学意义(P>0.05)。结论经ERCP和经PTCD途径胆道金属支架植入治疗MOJ均可取得显著的临床疗效,对于低位梗阻患者而言经ERCP更有优势,对于高位梗阻患者而言经PTCD途径更有优势。

Objective To compare the clinical effect of biliary metallic stenting via the endoscopic retrograde eholangiopanereatography （ERCP） route with that of biliary metallic stenting via the percutaneous transhepatie cholangial drainage （PTCD） route in treating malignant obstructive jaundice （MOJ）. Methods A total of 136 patients with MOJ, who were admitted to authors＇ hospital to receive biliary metallic stenting treatment during the period from June 2010 to June 2015, were included in this study. Of the 136 patients, stenting via ERCP route was employed in 53 （ERCP group） and stenting via PTCD route was adopted in 83 （PTCD group）. The surgical success rate, effective rate, incidence of postoperative complications, the hospitalization days and the medical expense were calculated and the results were compared between the two groups. Results （1） In patients with lower intestinal obstruction, the surgical success rates of the ERCP group and the PTCD group were 97.7% and 95.8% respectively, the difference was not statistically significant （P〉0.05）. In patients with higher intestinal obstruction, the surgical success rate of the ERCP group was remarkably lower than that of the PTCD group （77.8% vs. 98.3%）, the difference was statistically significant （P〈0.05）. （2） The total effective rates of the ERCP group and the PTCD group were 88.7% and 90.3% respectively, the difference was not statistically significant （P〉0.05）. In patients with lower intestinal obstruction, the effective rate of the ERCP group was 93.2%, which was obviously higher than 83.3% of the PTCD group, the difference was statistically significant （P〈0.05）. In patients with higher intestinal obstruction, the effective rate of the ERCP group was significantly lower than that of the PTCD group（66.7% vs. 93.2%）, the difterence was statistically significant （P〈0.05）. （3）The total incidence of postoperative complications of the ERCP group was 7.5%, which was strikingly lower than 15.7% of the PTCD group, the difference was statistically significant （P〈0.05）. In patients with lower intestinal obstruction, the incidence of complications in the ERCP group was 4.5%, which was significantly lower than 29.2% of the PTCD group, the difference was statistically significant （P〈0.05）. In patients with higher intestinal obstruction, the incidence of complications in the ERCP group was prominently higher than that in the PTCD group （22.2% vs. 10.2%）, the difference was statistically significant （P〈0.05）. （4） The mean hospitalization days of the ERCP group and the PTCD group were （13.67±2.25） days and （19.75±3.78） days respectively, the difference was statistically significant （P〈 0.05）. The average medical costs of the ERCP group and the PTCD group were （23 764.23±2 437.76） RMB and （24 863.45±2 983.37） RMB respectively, the difference was not statistically significant （P〉0.05）. Conclusion For the treatment of MOJ, biliary metal stent implantation, regardless of whether via ERCP route or via PTCD route is adopted, can achieve remarkable clinical curative effect. For the patients with lower intestinal obstruction the use of ERCP route has more advantages, while for the patients with higher intestinal obstruction the use of PTCD route can provide more advantages.