经皮肝穿刺胆道引流术和内镜下胆管内引流术对晚期恶性梗阻性黄疸患者围术期指标和术后并发症的影响

Effects of percutaneous transhepatic cholangial drainage and endoscopic retrograde biliary drainage on perioperative indicators and postoperative complications in patients with advanced malignant obstructive jaundice

目的:探讨经皮肝穿刺胆道引流术(PTCD)和内镜下胆管内引流术(ERBD)对晚期恶性梗阻性黄疸(MOJ)患者围术期指标和术后并发症的影响。方法:选取148例晚期MOJ患者为研究对象,根据治疗方式不同分为PTCD组(n=69)和ERBD组(n=79)。PTCD组行经皮肝穿刺胆道引流术,ERBD组行内镜下胆管内引流术。比较两组患者围术期指标、减黄效果、肝功能指标、免疫功能指标及术后并发症发生情况。结果:ERBD组术后首次下床活动及住院时间短于PTCD组(P<0.05),住院费用高于PTCD组(P<0.05)。术后1周,两组患者总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)、肝功能指标水平均较术降低(P<0.05),但组间比较,差异无统计学意义(P>0.05);两组患者IgA、IgG、IgM水平均降低,且PTCD组低于ERBD组(P<0.05)。ERBD组患者术后并发症发生率低于PTCD组(P<0.05)。结论:ERBD与PTCD两种术式对晚期MOJ患者均具有较好的减黄效果,可改善患者肝功能,但ERBD术式在患者术后并发症发生率、免疫功能及术后恢复方面更具优势。

Objective:To study the effects of percutaneous transhepatic cholangial drainage(PTCD)and endoscopic retrograde biliary drainage(ERBD)on perioperative indicators and postoperative complications in patients with advanced malignant obstructive jaundice(MOJ).Methods:148 patients with advanced MOJ were divided into PTCD group(n=69)and ERBD group(n=79)according to the treatment method.PTCD group received percutaneous transhepatic cholangial drainage,endoscopic retrograde biliary drainage was performed in ERBD group.The perioperative indicators,reduction of jaundice,changes in liver function indicators and immune function indicators were compared between the two groups.The incidence of postoperative complications was counted.Results:The first ambulation time and length of hospital stay of ERBD group were significantly shorterr than those of PTCD group,and hospitalization expenses was significantly more than that of PTCD group(P<0.05).The levels of total bilirubin(TBil),direct bilirubin(DBil),indirect bilirubin(IBil)and liver function indicators in the two groups were significantly reduced at 1 week after operation(P<0.05),but there was no significant difference between the two groups(P>0.05).The levels of IgA,IgG and IgM in the two groups were decreased,and the levels in PTCD group were lower than those in ERBD group(P<0.05).The incidence of postoperative complications in ERBD group was significantly lower than that in PTCD group(P<0.05).Conclusion:Both ERBD and PTCD are effective in reducing jaundice and improving liver function in patients with advanced MOJ.However,ERBD has more advantages in terms of the incidence of postoperative complications,immune function and postoperative recovery.