PTCD与ERCP+ENBD在恶性梗阻性黄疸姑息性治疗中疗效比较

Comparison of efficacy between PTCD and ERCP+ENBD in palliative treatment of malignant obstructive jaundice

目的探讨PTCD与ERCP+内镜下鼻胆管引流术(ENBD)在恶性梗阻性黄疸姑息性治疗中的疗效。方法回顾性分析2018年12月至2020年1月在昆明医科大学第二附属医院诊治的68例恶性梗阻性黄疸患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男37例,女31例;年龄27~85岁,中位年龄63岁。根据减黄术式分为PTCD组(36例)与ERCP+ENBD组(32例)。观察两组患者的黄疸缓解率及围手术期情况等。两组住院时间、住院费用比较采用t检验,率的比较采用χ^(2)检验或Fisher确切概率法。结果两组患者治疗后黄疸、皮肤瘙痒临床症状及肝功能较术前均有所改善。PTCD组高位梗阻黄疸缓解率为91%(20/22),明显优于ERCP+ENBD组的50%(6/12)(χ^(2)=7.222,P<0.05)。而ERCP+ENBD组低位梗阻黄疸缓解率为95%(18/19),明显优于PTCD组的64%(9/14)(χ^(2)=5.024,P<0.05)。PTCD组与ERCP+ENBD组术后总并发症发生率分别为17%(6/36)、32%(10/31),差异无统计学意义(χ^(2)=2.228,P>0.05)。ERCP+ENBD组术后急性胰腺炎发生率为13%(4/31),明显高于PTCD组的0(P=0.026)。PTCD组住院时间和费用分别为(15.6±2.7)d、(2.5±0.4)万元,明显少于ERCP+ENBD组的(18.7±2.3)d、(2.7±0.3)万元(t=-5.140,-2.910;P<0.05)。结论PTCD与ERCP+ENBD在治疗恶性梗阻性黄疸方面均可获得有效的临床效果,PTCD更适用于高位梗阻患者,而ERCP+ENBD更适用于低位梗阻患者。两种术式各具优劣,需根据患者病情综合考虑选择,才能使患者切实受益。

Objective To compare the efficacy of percutaneous transhepatic cholangial drainage(PTCD)and endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic nasobiliary drainage(ENBD)in the palliative treatment of malignant obstructive jaundice.Methods Clinical data of 68 patients with malignant obstructive jaundice admitted to the Second Affiliated Hospital of Kunming Medical University from December 2018 to January 2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,37 patients were male and 31 female,aged from 27 to 85 years,with a median age of 63 years.All patients were divided into the PTCD(n=36)and ERCP+ENBD groups(n=32).The jaundice remission rate and perioperative conditions between two groups were observed.The length of hospital stay and hospitalization expense between two groups were compared by t test.The rate comparison was conducted by Chi-square test or Fisher's exact probability test.Results After treatments,the clinical symptoms of jaundice,skin itching and liver function of patients were improved in two groups.In the PTCD group,the remission rate of high-position obstructive jaundice was 91%(20/22),significantly higher than 50%(6/12)in the ERCP+ENBD group(χ^(2)=7.222,P<0.05).In the ERCP+ENBD group,the remission rate of low-position obstructive jaundice was 95%(18/19),significantly higher compared with 64%(9/14)in the PTCD group(χ^(2)=5.024,P<0.05).The overall incidence of postoperative complications in the PTCD and ERCP+ENBD groups were 17%(6/36)and 32%(10/31),respectively.No statistical significance was noted between two groups(χ^(2)=2.228,P>0.05).In the ERCP+ENBD group,the incidence of postoperative acute pancreatitis was 13%(4/31),significantly higher compared with 0 in the PTCD group(P=0.026).In the PTCD group,the length of hospital stay and hospitalization expense were(15.6±2.7)d and(2.5±0.4)×10^(4) yuan,significantly less than(18.7±2.3)d and(2.7±0.3)×10^(4) yuan in the ERCP+ENBD group(t=-5.140,-2.910;P<0.05).Conclusions Both PTCD and ERCP+ENBD are effective treatments for malignant obstructive jaundice.PTCD is more suitable for patients with high-position obstructive jaundice,whereas ERCP+ENBD is recommended for those with low-position obstructive jaundice.Both operations have its own advantages and limitations.Conditions of the patients should be considered when making therapeutic option,which can only bring clinical benefits to the patients.