超声内镜引导下胆管引流与内镜逆行胰胆管造影引流在胃改道术后胆管恶性梗阻中应用的比较

Comparison between EUS-guided biliary drainage and ERCP for the malignant biliary obstruction in patients with surgically altered anatomy

[目的]探究超声内镜引导下胆管引流(endoscopic ultrasound-guided biliary drainage,EUS-BD)与内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)引流在胃改道术后胆管恶性梗阻中的应用及价值。[方法]对胃改道术后胆管恶性梗阻经EUS-BD途径(EUS-BD组)或ERCP途径(ERCP组)引流患者的技术成功率、临床成功率、操作时间、术后并发症、梗阻复发情况及生存时间等进行比较分析。[结果]EUS-BD组与ERCP组患者的年龄、性别、术前总胆红素水平比较差异无统计学意义(P>0.05),2组的技术成功率、临床成功率、术后并发症、梗阻复发率及术后生存时间比较差异无统计学意义(P>0.05)。EUS-BD组的手术时间明显短于ERCP组(P<0.001)。[结论]EUS-BD及ERCP引流在胃改道术后胆管恶性梗阻的患者中均能有效降低胆红素水平、改善胆道梗阻,EUS-BD相对ERCP操作时间明显缩短。

[Objective]To explore the application of endoscopic ultrasound-guided biliary drainage(EUS-BD)and endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of malignant biliary obstruction with surgically altered anatomy.[Methods]We retrospectively analyzed those patients with surgically altered anatomy who underwent EUS-BD or ERCP in the Digestive Endoscopy Center of Drum Tower Hospital between January 2017 and January 2020 by comparing the technical success rate,clinical success rate,total procedure time,the rates of overall adverse events and reintervention,and survival between the two groups.[Results]There were no significant differences in age,gender and initial total serum bilirubin levels between the two groups(P>0.05).No statistical differences were observed in the technical success rates,clinical success rates,the rates of overall adverse events and reintervention,survival between the two groups(P>0.05).Total procedure time was statistically shorter in those patients who underwent EUS-BD(P<0.001).[Conclusion]The treatment of EUS-BD or ERCP can effectively reduce the level of bilirubin and relief the malignant biliary obstruction in patients with surgically altered anatomy.Total procedure time of EUS-BD is shorter than that of ERCP.