三种胆道外引流术治疗梗阻性黄疸的短期疗效及术后肝功能的影响

The short-term effect of three kinds of biliary drainage on obstructive jaundice and influence of postoperative liver function

目的研究三种不同的胆道引流术对梗阻性黄疸的短期疗效及术后肝功能的影响。方法回顾性分析2016年7月至2019年6月收治的106例恶性梗阻性黄疸患者临床资料。按其治疗术式将其分为三组:ERCP组、PTCD组、EUS-BD组。采用统计软件SPSS 24.0进行数据处理。患者住院时间、肝功能指标等计量资料采用(±s)表示,三组组间比较采用单因素方差分析,组间两两比较采用LSD-t检验;术后并发症发生率采用χ2检验;以P<0.05为差异有统计学意义。结果三组患者均成功完成手术,术后各项临床症状均得以缓解。三组患者平均住院天数EUS-BD组<ERCP组<PTCD,差异有统计学意义(P<0.001);术后7 d三组患者肝功能各项指标均明显下降,与术前相比,差异均有统计学意义(P<0.05);ERCP组患者总缓解率为74.3%(26/35),PTCD组及EUS-BD组分别为77.3%(34/44)、77.8%(21/27)差异无统计学意义(P>0.05);ERCP组患者术后并发症发生率14.3%,PTCD组34.1%,EUS-BD组7.4%,差异有统计学意义(P=0.013)。结论ERCP、PTCD及EUS-BD三种引流方式对于恶性梗阻性黄疸的短期疗效相当,其中EUS-BD并发症较少、恢复更快、优势更大。

Objective To study the short-term effect of three kinds of biliary drainage on obstructive jaundice and influence of postoperative liver function.Methods The clinical data of 106 patients with malignant obstructive jaundice from July 2016 to June 2019 were analyzed retrospectively.The patients were divided into three groups according to their treatment methods:ERCP group,PTCD group and EUS-BD group.The data were analyzed by SPSS24.0 statistical software.Among them,hospitalization time and liver function index were expressed by(±s).The data among three different groups were compared by one-way ANOVA,two different data in one group were compared by LSD-t test.The incidence of postoperative complications was compared byχ2 test.P<0.05 was considered statistically significant.Results All the patients in the three groups completed the operation successfully,and all the clinical symptoms were relieved.The average hospitalization days of the three groups showed as:EUS-BD group<ERCP group<PTCD group(P<0.001).All indexes of liver function in the three groups decreased significantly on day 7 after surgery,and the differences were statistically significant compared with those before surgery(P<0.05).The total remission rate was 74.3%(26/35)in the ERCP group,77.3%(34/44)in the PTCD group and 77.8%(21/27)in the EUS-BD group(P>0.05).The incidence of postoperative complications was 14.3%in the ERCP group,34.1%in the PTCD group,and 7.4%in the EUS-BD group,with statistically significant differences(P=0.013).Conclusion ERCP,PTCD and EUS-BD drainage have the same short-term therapeutic effect on malignant obstructive jaundice,while EUS-BD has less complications,faster recovery and greater advantages.