两种不同引流途径行胆道金属支架引流术对恶性梗阻性黄疸姑息性的治疗效果

Impact of two different biliary metal stent drainage channels on palliative care outcomes in malignant obstructive jaundice

目的探讨采用两种不同引流途径行胆道金属支架引流术(EMBE)减黄治疗恶性梗阻性黄疸(MOJ)的效果和安全性。方法选择2019年1月至2021年9月海安市中医院收治的MOJ患者112例,根据随机数字表示法分成观察组和对照组,每组各56例。观察组采用经内镜逆行性胰胆管造影术(ERCP)行EMBE治疗,对照组采用经皮肝穿刺胆道引流术(PTCD)行EMBE治疗。观察围术期指标,炎症免疫和肝功能更指标的变化,以及治疗效果和安全性。结果两组的手术时间和术中出血量差异无统计学意义(P>0.05);ERCP组开始下床时间、首次住院时间和住院总费用为(29.46±6.30)h、(4.52±0.76)d和(3.93±0.47)万元,低于PTCD组的(32.75±6.25)h、(5.19±0.85)d和(4.46±0.58)万元,差异有统计学意义(t=6.527、6.293、6.043,均P<0.05)。治疗7 d后,两组的NLR、TNF-α和sIL-2R水平均较治疗前显著下降(P<0.05),治疗后组间差异无统计学意义(P>0.05)。ERCP组的TBil、ALP和Alb为(146.59±24.83)μmol/L、(168.34±31.65)U/L和(32.18±2.49)g/L,低于PTCD组的(180.27±31.54)μmol/L、(201.87±39.25)U/L和(30.83±2.27)g/L,差异有统计学意义(t=8.023、7.495、5.876,均P<0.05)。两组的手术成功率和总缓解率比较差异无统计学意义(P>0.05);ERCP组的高位梗阻缓解率为53.33%,低于PTCD组的85.71%,低位梗阻缓解率和1年生存率为90.24%和30.36%,高于PTCD组的64.29%和16.07%,差异有统计学意义(χ^(2)=5.276、5.481、4.297,均P<0.05)。ERCP组的急性胰腺炎发生率为7.14%,高于PTCD组的0,胆道感染发生率为3.57%,相对于PTCD组的7.14%,差异有统计学意义(χ^(2)=5.239、4.351,均P<0.05);两组的胆道出血、胆漏和支架移位滑脱和并发症总发生率比较差异无统计学意义(P>0.05)。结论ERCP和PTCD行EMBE治疗MOJ患者均具有较好的疗效,安全性较高,ERCP更适用于低位MOJ,PTCD更适用于高位MOJ。

Objective To evaluate the therapeutic efficacy and safety profile of two distinct biliary metal stent drainage(EMBE)methods in the management of malignant obstructive jaundice(MOJ).Methods A total of 112 patients diagnosed with MOJ between January 2019 and September 2021 were enrolled in this study.Patients were evenly allocated into either observation group or control group,each containing 56 participants.The observation group underwent EMBE facilitated by endoscopic retrograde cholangiopancreatography(ERCP),whereas the control group received percutaneous transhepatic biliary drainage(PTCD).Various metrics,including perioperative markers,inflammatory and immunological profiles,liver function tests,indices of therapeutic effecacy and safety,were meticulously evaluated.Results There were no statistically significant differences between the two groups in terms of operative time and intraoperative blood loss(P>0.05).Patients in the ERCP group had shorter initial out-of-bed times(29.46±6.30 h),shorter first hospotal stays(4.52±0.76 d),and lower total hospitalization costs(3.93±0.47 million yuan)compared to those in the PTCD group(32.75±6.25 h,5.19±0.85 d and 4.46±0.58 million yuan,respectively;t=6.527,6.293,6.043,all P<0.05).After one week of treatment,both groups exhibited significant reductions in NLR,TNF-αand sIL-2R levels compared to pre-treatment baselines(P<0.05).However,post-treatment levels were not significantly different between the groups(P>0.05).Liver function indicators,including TBIL,ALP and ALB,were significantly improved in the ERCP group(146.59±24.83μmol/L,168.34±31.65 U/L,32.18±2.49 g/L)compared to the PTCD group(180.27±31.54μmol/L,201.87±39.25 U/L and 30.83±2.27 g/L;t=8.023,7.495,5.876,all P<0.05).No significant differences were observed in surgical success rates or total remission rates between the two groups(P>0.05).The ERCP group had lower remission rate of high obstruction(53.33%)compared to the PTCD group(85.71%),but a higher remission and one-year survival rate for low obstruction(90.24%and 30.36%,respectively)compaared to the PTCD group(64.29%and 16.07%;χ^(2)=5.276,5.481,4.297,P<0.05).In terms of complications,the The ERCP group had a higher incidence of PEP(7.14%),compared to the PTCD group(0%).The incidence of biliary tract infection was 3.57%in the ERCP group versus 7.14%in PTCD group,with the difference being statistically significant(χ^(2)=5.239,4.351,both P<0.05).No significant differences were noted in the overalll incidence rates of biliary bleeding,biliary leakage,stent displacement,slippage,or other complications between the two groups(P>0.05).Conclusion Both ERCP and PTCD demonstrate robust efficacy and a high safety profile in treating patients with MOJ,complicated by EMBE.Specifically,ERCP is particularly advantageous for treatling lower MOJ cases,whereas PTCD exhibits greater suitability for addresing upper MOJ conditions.