两种不同手术方式治疗恶性梗阻性黄疸患者的临床疗效比较研究

目的:探讨经皮肝穿刺胆管引流术(PTCD)与经内镜逆行胰胆管造影术(ERCP)治疗恶性梗阻性黄疸的治疗效果,并进行比较分析。方法:选取2016年1月~2018年5月期间我院收治的127例恶性梗阻性黄疸患者。根据治疗术式的不同将患者分为ERCP组(n=63,采用ERCP联合金属支架置入术进行治疗)和PTCD组(n=64,采用PTCD进行治疗),比较两组患者术后5d黄疸缓解率,比较两组患者术前、术后2周肝功能指标血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)、直接胆红素(DBIL)],比较两组患者术后舒适度量表评分情况及并发症发生情况。结果:两组患者术后黄疸总缓解率比较差异无统计学意义(P0.05);PTCD组低位梗阻患者黄疸缓解率低于ERCP组,而高位梗阻患者黄疸缓解率高于ERCP组(P0.05)。两组患者术前、术后2周TBIL、ALT、DBIL比较差异无统计学意义(P0.05);两组患者术后2周TBIL、ALT、DBIL水平较术前比较均下降(P0.05)。ERCP组患者术后舒适度量表评分总分低于PTCD组,差异有统计学意义(P0.05)。PTCD组术后并发症总发生率14.06%(9/64),低于ERCP组的41.27%(26/63)(P0.05)。结论:ERCP与PTCD治疗恶性梗阻性黄疸均可改善患者肝脏功能、疗效满意,但ERCP对低位梗阻患者治疗效果优于PTCD,且术后舒适度优于PTCD,但术后并发症较多,临床应根据患者情况选择具体术式。

Comparative Study of Clinical Efficacy of two Different Surgical Methods in the Treatment of Malignant Obstructive Jaundice

ABSTRACT Objective: To evaluate the curative effect of percutaneous transhepatic cholangial drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of malignant obstructive jaundice,and to make a comparative analysis. Methods: A total of 127 cases of malignant obstructive jaundice, who were admitted to Affiliated Hanzhong 3201 Hospital of Xi''an Jiaotong University School of Medicine from January 2016 to May 2018, were selected and were divided into ERCP group (n=63, treated with ERCP combined with metal stenting) and PTCD group (n=64, treated with PTCD) according to the different therapeutic methods.The jaundice remission rates was compared between the two groups 5 days after operation; the liver function indexes (serum total bilirubin (TBIL), alanine aminotransferase (ALT) and direct bilirubin (DBIL) were compared between the two groups before operation and 2 weeks after operation.The postoperative comfort scale scores and complications were compared between the two groups. Results: There was no significant difference in the total jaundice remission rates between the two groups (P>0.05). The jaundice remission rates with the low obstruction patients in the PTCD group was lower than that in ERCP group, while the jaundice remission rates with the high obstruction patients was higher than that in ERCP group (P<0.05). There was no significant difference in TBIL,ALT and DBIL between the two groups before operation and 2 weeks after operation (P>0.05). The levels of TBIL, ALT and DBIL in the two groups was decreased 2 weeks after operation (P<0.05). The total score of postoperative comfort scale in the ERCP group was lower than that in the PTCD group, and the difference was statistically significant (P<0.05). The total incidence of postoperative complications in the PTCD group was 14.06% (9/64), which was lower than that in the ERCP group (41.27% (26/63) )(P<0.05). Conclusion: Both ERCP and PTCD can improve the liver function and curative effect in the treatment of malignant obstructive jaundice. ERCP is superior to PTCD in the treatment of low obstruction patients, and postoperative comfort is better than PTCD, but there are more postoperative complications. So the specific operation should be chosen according to the clinical patient''s situation.