PTCD与ERCP治疗对不可手术切除的高位恶性梗阻性黄疸患者肝功能及预后生存期的影响观察

Observation of the effects of PTCD and ERCP treatment on liver function and prognosis survival in patients with unresectable high malignant obstructive jaundice

目的比较经皮肝穿刺胆道引流术(PTCD)与经内镜逆行性胰胆管造影术(ERCP)治疗对不可手术切除的高位恶性梗阻性黄疸(MOJ)患者肝功能及预后生存期的影响。方法选取2021年5月~2023年3月辽宁省金秋医院联合辽宁省人民医院收治的MOJ患者90例,按照治疗方式不同,将采用PTCD治疗的47例患者作为PTCD组,将采用ERCP治疗的43例患者作为ERCP组。比较两组患者术后2周的临床疗效、手术相关指标(手术时间、术中出血量、胆汁引流量和术后住院时间)、肝功能[总胆红素(TBIL)、直接胆红素(DBIL)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷胺酰转肽酶(GGT)]以及术后1年的并发症、预后生存期。结果PTCD组临床总有效率为93.62%,高于ERCP组的79.07%(P<0.05)。两组手术时间、术中出血量和胆汁引流量比较,均无明显差异(P>0.05);PTCD组术后住院时间长于ERCP组(P<0.05)。术后2周,PTCD组TBIL、DBIL、AST、ALP和GGT水平分别为(87.12±10.03)μmol/L、(83.58±9.63)μmol/L、(78.06±8.51)U/L、(286.43±26.65)U/L和(195.77±18.46)U/L,均低于ERCP组的(99.23±10.89)μmol/L、(100.29±11.47)μmol/L、(89.96±9.27)U/L、(327.65±29.78)U/L和(219.56±20.37)U/L(P<0.05)。两组气胸、出血、胰腺炎和胆道感染等并发症总发生率比较,无明显差异(P>0.05)。PTCD组术后1年生存率(80.85%)高于ERCP组(65.12%)(P<0.05)。结论相较ERCP,PTCD治疗高位MOJ的疗效更佳,能有效改善患者肝功能,并发症发生率更低,且预后更好,但术后恢复过程相对略慢。

Objective To observe the effects of percutaneous transhepatic cholangial drainage(PTCD)and endoscopic retrograde cholangiopancreatography(ERCP)treatment on liver function and prognosis survival in patients with unresectable high malignant obstructive jaundice(MOJ).Methods A total of 90 patients with MOJ admitted to Liaoning Jinqiu Hospital and the People’s Hospital of Liaoning Province from May 2021 to March 2023 were selected.According to different treatment methods,47 patients treated with PTCD were selected as PTCD group,and 43 patients treated with ERCP were selected as ERCP group.The clinical efficacy,surgery related indicators(operation time,intraoperative blood loss,bile drainage volume and postoperative hospital stay),liver function[total bilirubin(TBIL),direct bilirubin(DBIL),aspartate aminotransferase(AST),alkaline phosphatase(ALP),and glutamyl transpeptidase(GGT)]at two weeks after operation,complications and prognosis survival at 1 year after operation were compared between the two groups.Results The total effective rate of PTCD group was 93.62%,which was higher than 79.07%of ERCP group(P<0.05).The postoperative hospital stay in PTCD group was longer than that in ERCP group(P<0.05).Two weeks after operation,the levels of TBIL,DBIL,AST,ALP and GGT in PTCD group were(87.12±10.03)μmol/L,(83.58±9.63)μmol/L,(78.06±8.51)U/L,(286.43±26.65)U/L and(195.77±18.46)U/L,respectively,which were lower than(99.23±10.89)μmol/L,(100.29±11.47)μmol/L,(89.96±9.27)U/L,(327.65±29.78)U/L and(219.56±20.37)U/L in ERCP group(P<0.05).There was no significant difference in the total incidence of complications such as pneumothorax,hemorrhage,pancreatitis and biliary tract infection between the two groups(P>0.05).The 1-year survival rate after operation of PTCD group(80.85%)was higher than that of ERCP group(65.12%)(P<0.05).Conclusion Compared with ERCP,PTCD is more effective in the treatment of high MOJ,which can effectively improve the liver function of patients,with lower incidence of complications and better prognosis,but the postoperative recovery process is relatively slow.