ERCP和PTCD治疗结石性梗阻性黄疸的对比研究

A comparative study of ERCP and PTCD in the treatment of calculus obstructive jaundice

目的探讨经内镜逆行性胰胆管造影(ERCP)及经皮肝穿刺胆道引流(PTCD)对结石性梗阻性黄疸的治疗的手术疗效。方法回顾性分析我院自2014年1月~2016年10月收治的行微创治疗的结石性梗阻性黄疸患者47例,根据手术方法的不同,将47例结石性梗阻性黄疸患者分为ERCP组(n=28)和PTCD组(n=19)。收集所有患者入院至出院的临床数据,比较黄疸相关的一般状况、生化指标及并发症,观察两种不同的手术方式对梗阻性黄疸的手术治疗疗效。结果两组患者术前基本情况无显著性差异。术后第1天ERCP组患者的总胆红素水平显著低于PTCD组[(283.6±65.2)μmol/L vs(327.0±62.5)μmol/L],差异有统计学意义(P<0.05);但术后1周两组总胆红素水平差异不显著,无统计学意义(P>0.05)。术后谷丙转氨酶水平ERCP组显著高于PTCD组[术后1 d(142.7±30.6)IU/L vs(124.9±25.5)IU/L;术后1周(85.6±18.4)IU/L vs(69.5±14.9)IU/L],差异有统计学意义(P<0.05)。两组患者术后并发胰腺炎水平无统计学意义(P>0.05)。结论两种手术方法均能有效缓解患者黄疸症状,改善患者肝功能,但ERCP能从根本上解除患者梗阻,对于结石性梗阻性黄疸更倾向于行ERCP术。

Objective To evaluate the curative effect of endoscopic retrograde cholangiopancreatography（ERCP） and percutaneous transhepatic bile duct drainage （PTCD） in the treatment of calculous obstructive jaundice. Methods 47 cases of calculous obstructive jaundice treated by minimally invasive treatment in our hospital from January 2014 to October 2016 were analyzed retrospectively. According to the different surgical methods, 47 patients with calculous obstructive jaundice were divided into ERCP group（n=28） and PTCD group （n=19）. The clinical data of all patients from admission to discharge were collected. The general condition, biochemical indices and complications of jaundice were compared. The jaundice＇related general status, biochemical indicators and complications were compared. And the curative effect of two different surgical methods on obstructive jaundice was observed. Results There was no significant difference in the preoperative data between the two groups. The total bilirubin level in the ERCP group was significantly lower than that in the PTCD group the first day after surgery[（283.6±65.2）p, mol]L vs （327.0±62.5）μmol/L], and the difference was statistically significant（P〈0.05）. But there was no significant difference in the total bilirubin level between the two groups one week after surgery（P〉0.05）. The postoperative alanine aminotransferase level in the ERCP group was significantly higher than that in the PTCD group [postoperative one day： （142.7±30.6）IU/L vs （124.9±25.5）IU/L; one week after surgery：（85.6±18.4）IU/L vs （69.5±14.9）IU/L], and the difference was signifieant（P〈0.05）. The difference was no statistically significant in postoperative concurrent panereatitis between the two groups（P〉0.05）. Conclusion Both operation methods can effectively relieve the symptoms of jaundice in patients and improve their liver function, but ERCP can relieve the obstruction of patients, fundamentally remove the patient＇ obstruction, which is more preferred for calculous obstructive jaundice.