超声引导经皮肝穿胆道引流与逆行胰胆管造影支架置入术治疗恶性梗阻性黄疸的临床研究

Effect of ultrasound-guided percutaneous transhepatic cholangial drainage and endoscopic retrograde cholangiopancreatography stent placement in the treatment of malignant obstructive jaundice and its influence on liver function

目的分析恶性梗阻性黄疸采用超声引导下经皮肝穿刺胆道引流术(PTCD)与内镜逆行胰胆管造影(ERCP)支架置入术的临床疗效并探讨对肝功能的影响.方法对2018年1月至2020年11月医院收治的106例恶性梗阻性黄疸患者的临床资料进行回顾性分析,其中采用超声引导下PTCD术者50例为A组,采用ERCP支架置入术者56例,为B组.比较两组围术期指标变化及术后恢复情况,比较两组手术前后的肝功能指标及炎症因子变化,统计并对比两组缓解率及并发症发生情况.结果两组手术耗时及术中失血量比较,差异无统计学意义(P>0.05),B组术后开始下床活动时间及住院时间均短于A组(P<0.05).术后两组内总胆红素(TBIL)、谷草转氨酸(AST)及直接胆红素(DBIL)均较术前降低(P<0.05),两组间术前、术后TBIL、AST、DBIL比较,差异无统计学意义(P>0.05).术后两组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平均较术前降低(P<0.05),两组间术前、术后TNF-α、IL-6、IL-8比较,差异无统计学意义(P>0.05).A组的高位缓解率高于B组,低位缓解率低于B组(P<0.05),两组的总缓解率比较,差异无统计学意义(P>0.05).A组胆道感染、急性胰腺炎发生率及总并发症发生率低于B组(P<0.05),两组胆漏及出血发生率比较差异无统计学意义(P>0.05).结论超声引导下PTCD与ERCP支架置入术治疗恶性梗阻性黄疸均可有效缓解黄疸症状、促进肝功能的恢复,减轻炎症反应,PTCD更适用于高位梗阻且并发症发生率更低,ERCP支架置入术更适用于低位梗阻且术后恢复更快.

Objective To analyze the clinical efficacy of ultrasound-guided percutaneous transhepatic cholangial drainage(PTCD)and endoscopic retrograde cholangiopancreatography(ERCP)stent placement for malignant obstructive jaundice,and to explore the impact on liver function.Methods The clinical data of 106 patients with malignant obstructive jaundice admitted to our hospital from January 2018 to November 2020 were retrospectively analyzed.Among them,50 patients underwent PTCD under ultrasound-guided as group A.56 patients received ERCP stent implantation as group B.The perioperative indexes and postoperative recovery of the two groups were compared.The changes of liver function indexes and inflammatory factors before and after operation were compared between the two groups.The remission rate and complications were compared between the two groups.Results There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).The time of getting out of bed and hospitalization time in group B were shorter than those in group A(P<0.05).The levels of total bilirubin(TBIL),aspartate transaminase(AST)and direct bilirubin(DBIL)in the two groups were lower than those before operation(P<0.05).There was no significant difference in TBIL,AST and DBIL between the two groups before and after operation(P>0.05).The levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)in the two groups after operation were lower than those before surgery(P<0.05).There was no significant difference in TNF-α,IL-6,and IL-8 before and after operation between the two groups(P>0.05).The high remission rate of group A was higher than that of group B,and the low remission rate was lower than that of group B(P<0.05).There was no significant difference in the total remission rate between the two groups(P>0.05).The incidence of biliary tract infection,acute pancreatitis and total complications in group A were lower than those in group B(P<0.05).There was no significant difference in the incidence of bile leakage and bleeding between the two groups(P>0.05).Conclusion Both under ultrasound-guidance PTCD and ERCP stent placement can effectively relieve jaundice symptoms and promote the recovery of liver function,and reduce inflammation.PTCD is more suitable for high obstruction and has a lower complication rate.ERCP stent placement is more effective.It is suitable for low obstruction and recovers faster after operation.