ERCP及PTCD治疗低位恶性梗阻性黄疸疗效分析

The efficacy of ERCP and PTCD in the treatment of low malignant obstructive jaundice

目的观察逆行性胰胆管造影(ERCP)及超声引导下经皮肝穿刺胆管造影引流术(PTCD)途径置入胆管金属支架治疗低位恶性梗阻性黄疸(MOJ)的临床疗效。方法选取2016年7月-2018年6月期间于蚌埠医学院第一附属医院消化科及肝胆外科接受治疗的138例MOJ患者为研究对象,根据患者住院期间的手术方式,分为PTCD组(n=65)和ERCP组(n=73);将两组患者的手术成功情况、黄疸消退情况、住院总天数、住院总费用以及术后常见的并发症作为观测指标,进行回顾性对比研究。结果手术成功率方面,ERCP组为93.15%,高于PTCD组(81.54%),P<0.05;患者手术后黄疸缓解率方面,ERCP组(91.78%)明显高于PTCD组(78.46%),P<0.05;住院总天数及总费用方面,ERCP组较PTCD组明显减少,P<0.001;手术后常见的并发症情况,ERCP发生率为5.48%,PTCD组为20.00%,差异具有统计学意义(P<0.05)。结论经ERCP途径胆管金属支架置入术,具有较高的手术成功率,术后效果好,且住院时间短、并发症少以及整体花费少等优点,值得临床推广应用。

Objective To observe the clinical effect of biliary metallic stent implantation via endoscopic retrograde cholangiopancreatography(ERCP)and ultrasound-guided percutaneous transhepatic cholangiography and drainage(PTCD)approaches in treatment of malignant obstructive jaundice(MOJ)in the low bile duct.Methods A total of 138 MOJ patients who received treatment in Gastroenterology Department and Hepatobiliary Surgery Department of the First Affiliated Hospital of Bengbu Medical College from July 2016 to June 2018 were selected as the study subjects.The patients were divided into ERCP group(n=73)and PTCD group(n=65)according to the surgical way that patients delected.Surgical success,jaundice regression,total hospitalization days,total hospital expenses and common postoperative complications of patients in the two groups were taken as the observation indicators to conduct a retrospective comparative study.Results The operation success rate of ERCP group(93.15%)was higher than that of PTCD group(81.54%),P<0.05.The jaundice remission rate of ERCP group(91.78%)was obviously higher than that of PTCD group(78.46%),P<0.05.The total hospitalization days,total hospitalization expenses of the ERCP group were obviously less than those of PTCD group,P<0.001.The incidence of common postoperative complications was 5.48%in ERCP group and 20.00%in PTCD group,the difference was statistically significant(P<0.05).Conclusion Biliary metallic stent implantation via ERCP approach has the advantages of high surgical success rate,good postoperative effect,short hospitalization duration,less complications and less overall expenses,and is worthy of clinical promotion and application.