经内镜与经皮肝穿植入金属自膨胀式支架解除胆管恶性梗阻疗效比较

Comparison of self-expandable metallic stent(SEMS) implantation by ERCP and PTCD in treating malignant biliary obstruction

目的对比分析金属自膨胀式支架(SEMS)经内镜(ERCP)与经皮肝穿(PTCD)植入治疗胆管恶性梗阻疗效。方法对2007年1月至2017年12月粤北人民医院经内镜或经皮肝穿植入SEMS的50例胆管恶性梗阻患者进行回顾性分析。其中ERCP组28例,PTCD组22例。对比两种支架植入成功率、30 d内病死率、术前及术后5~7 d肝功能的差异、术后1周生活质量、术后近期并发症等指标。结果ERCP组与PTCD组相比,支架植入成功率、30 d内病死率差异无统计学意义(P>0.05),2例经ERCP失败改PTCD植入成功。两组术前5~7 d肝功能指标(TBil、DBil、AST、ALT、AKP、GGT)差异无统计学意义(P>0.05);术后均较术前显著降低(P<0.01)。两组术后近期并发症发生率无统计学意义(P>0.05)。ERCP组术后1周生活质量与术前比较有显著改善(P<0.01),且优于PTCD组(P<0.01)。结论经内镜与经皮肝穿植入SEMS解除胆管恶性梗阻的疗效、30 d病死率和术后并发症相当,但ERCP组术后1周生活质量优于PTCD组。

Objective To compare the efficacy of self-expandable metallic stent （SEMS） implantation by ERCP and PTCD in treating malignant biliary obstruction. Methods The data of 50 patients with malignant biliary obstruction treated by implanting SEMS by ERCP or PTCD in Yuebei People＇s Hospital from January 2007 to December 2017 were compared. The implantation of SEMS by ERCP was performed in 28 patients and by PTCD in 22 patients. Success rate of stent implantation, mortality rate within 30 days, difference of liver function between pre-operation and 5 - 7 days after operation, recent post-operative complications and quality of life in one week were compared between the two groups. Result There was no significant difference in the success rate of stent implantation and mortality within 30d between ERCP group and PTCD group （P 〉 0.05）, and 2 patients were successfully implanted with PTCD after failure of ERCP. There was no significant difference in liver function indexes （TBil, DBil, AST, ALT, AKP, GGT） between the two groups before operation （P 〉 0.05）, but they were significantly decreased after the operation in both two groups （P 〈 0.01）. There was no significant difference in short-term post-operative complications between the two groups （P 〉 0.05）.The quality of life in group ERCP was significantly improved 1 week after operation （P 〈 0.01）, and was significantly better than that in group PTCD （P 〈 0.01）. Conclusion The curative effect, the mortality rate within 30 days and the pos-toperative complications were equivalent in the treatment of malignant obstruction of bile duct by endoscopic and percutaneous transhepatic implantation of SEMS, but the quality of life in group ERCP was better than that of group PTCD at 1 week after operation.