ERCP置入金属支架与PTCD治疗肝外胆管恶性肿瘤致梗阻性黄疸的对比研究

Comparative study of ERCP and PTCD in the treatment of obstructive jaundice caused by malignant extrahepatic bile duct tumors

目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例。对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗。比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异。结果观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01)。观察组和对照组患者的术后黄疸缓解率(93.33%vs.84.44%)和发热发生率(24.44%vs.33.33%)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89%)较对照组(31.11%)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05)。观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01)。观察组患者的术后并发症总发生率(6.67%)较对照组(26.67%)明显降低,差异具有统计学意义(P<0.05)。结论对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸。但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法。

Objective To compare the clinical efficacy of endoscopic retrograde cholangiopancreatography(ERCP)with percutaneous transhepatic cholangiopuncture and drainage(PTCD)in the treatment of obstructive jaundice caused by malignant extrahepatic bile duct tumors.Methods Ninety patients with obstructive jaundice caused by malignant extrahepatic bile duct tumors from Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to January 2018 were randomly divided into two groups by using simple random grouping method,control group treated with percutaneous transhepatic biliary puncture and drainage and observation group treated with ERCP metal stent implantation,45 cases in each group.The hospitalization days,jaundice remission rate,abdominal pain,fever,stent patency time,complications and total survival time were compared between the two groups.Results The hospitalization days of patients in the observation group[(12.53±3.98)d]were significantly shorter than those in the control group[(18.77±4.26)d],and the difference was statistically significant(P<0.01).There was no significant difference in jaundice remission rate(93.33%vs.84.44%)and fever rate(24.44%vs.33.33%)between the two groups(P>0.05).The incidence of abdominal pain in the observation group(8.89%)was significantly lower than that in the control group(31.11%)(P<0.05).The disappearance time of abdominal pain(6.95±1.35 d vs.7.38±1.46 d)and the recovery time of body temperature(2.48±0.69 d vs.2.74±0.83 d)in the two groups were not significantly different(P>0.05).The stent patency time[(224.85±48.95)d]and total survival time[(331.14±46.84)d]in the observation group were significantly longer than those in the control group[(157.89±42.16)d,(223.16±39.80)d],and the difference was statistically significant(P<0.01).The total incidence of postoperative complications in the observation group(6.67%)was significantly lower than that in the control group(26.67%),the difference was statistically significant(P<0.05).Conclusion For patients with obstructive jaundice caused by malignant extrahepatic bile duct tumors,ERCP implantation of metal stents is equivalent to percutaneous transhepatic biliary puncture and drainage,and can effectively relieve biliary obstructive jaundice.However,compared with PTCD,ERCP metal stent implantation can prolong biliary tract patency time,shorten hospitalization time and reduce complications.It can promote liver function recovery and prolong survival time.Therefore,ERCP metal stent implantation can be used as a safe and effective treatment for such patients.