肝门部胆管癌患者术前经内镜下胆道引流与经皮经肝胆道穿刺引流的效果比较

Comparison of Clinical Effects about Hilar Cholangiocarcinoma Operation of Patients after Preoperative Biliary Drainage by EBD and PTBD

目的:比较肝门部胆管癌(HCCA)患者术前经内镜下胆道穿刺引流(EBD)与经皮经肝胆道引流(PTBD)的效果。方法:将2013年1月1日—2018年12月31日于我院就诊的112例HCCA患者纳入研究。其中术前行PTBD引流65例,EBD引流47例。比较两种引流的效果、并发症及对手术效果的影响。结果:两组患者年龄、性别、引流前血清胆红素峰值水平、合并高血压、糖尿病、肝硬化等一般病理特征差异无统计学意义。65例PTBD组有39例(60%)首次插管引流成功引流,47例EBD组有27例(57.4%)首次插管引流成功引流,两组差异无统计学意义。EBD组引流后并发症总发生率(53.1%,25/47)高于PTBD组(24.6%,16/65),差异有统计学意义(χ2=9.594,P=0.019)。PTBD组较EBD组有更好的平均减黄疗效(t=3.264,P=0.001)。PTBD组最常见的并发症是引流管脱落,其次是胆管炎和引流管堵塞。而EBD组最常见的并发症是胆管炎,其次是胰腺炎和出血。EBD组胆管炎及胰腺炎的发生率高于PTBD组(P<0.05)。两组间引流管脱落、堵塞、出血等并发症发生率差异无统计学意义(P>0.05)。PTBD组总体复发率为58.4%(38/65);低于EBD组70.2%(33/47),差异有统计学意义(HR=0.452,95%CI:0.267~0.766,P=0.003)。PTBD组5年总体生存率为30.7%,与EBD组31.9%差异无统计学意义(HR=0.975,95%CI:0.617~1.540,P=0.914)。结论:HCCA患者术前行EBD与PTBD胆道引流均可取得理想疗效,但PTBD引流成功率更高,并发症更少,比EBD更适合在基层医疗机构推广。但PTBD具有肿瘤沿窦道种植转移的缺点,在应用过程中应特别注意。

Objective To compare the effect of preoperative endoscopic biliary drainage(EBD)and percutaneous transhepatic biliary drainage(PTBD)in patients with hilar cholangiocarcinoma(HCCA).Methods 112 cases of HCCA patients admitted to our hospital from January 1,2013 to December 31,2018 were included in the study.Among them,65 cases received PTBD drainage and 47 cases received EBD drainage.The effects,complications and effects of two drainage methods were compared.Results There were no significant differences in age,gender,serum bilirubin peak level before drainage,combined with hypertension,diabetes,cirrhosis and other general pathological features between the two groups.In 65 patients with PTBD group,39(60%)were successfully drained with the first intubation,while in 47 patients with EBD group,27(57.4%)were successfully drained with the first intubation.The total incidence of complications after drainage in EBD group(53.1%,25/47)was higher than that in PTBD group(24.6%,16/65),which the difference was statistically significant(χ^2=9.594,P=0.019).Compared with the EBD group,the PTBD group had better biliary drainage effect(t=3.264,P=0.001).The most common complications in PTBD group were drainage tube detachment,followed by cholangitis and drainage tube blockage.The most common complication in EBD group was cholangitis,followed by pancreatitis and hemorrhage.The incidence of cholangitis and pancreatitis in EBD group was higher than that in PTBD group(P<0.05).There was no significant difference between the two groups(P>0.05).The difference in tumor recurrence rate between the two groups was statistically significant(HR=0.452,95%CI:0.267-0.766,P=0.003).Median survival time was not statistically significant(HR=0.975,95%CI:0.617-1.540,P=0.914).Conclusion Preoperative biliary drainage in HCCA patients with EBD and PTBD can achieve ideal efficacy.However,PTBD has a higher success rate of drainage and fewer complications in patients with hilum cholangiocarcinoma,which is more valuable for promotion in primary medical institutions.However,PTBD has the disadvantage of tumor spreading along the duct,which should be paid attention to in the application process.