经皮肝穿刺胆道引流术与逆行胰腺胆管造影术对结石性梗阻性黄疸患者的疗效比较研究

目的:比较经皮肝穿刺胆道引流术(PTCD)与逆行胰腺胆管造影术(ERCP)对结石性梗阻性黄疸患者的治疗效果。方法:选取海军军医大学第三附属医院东方肝胆外科医院于2016年3月～2018年4月间收治的结石性梗阻性黄疸患者80例。按照介入治疗术式的异同将患者分为ERCP组(n=40,给予ERCP治疗)和PTCD组(n=40,给予PTCD治疗),记录两组手术时间、术中出血量、住院费用、住院时间、治疗成功率、黄疸缓解率、并发症发生情况,比较两组术前、术后1 d、术后7 d肝功能指标情况。结果:两组患者手术时间、术中出血量、治疗成功率、黄疸缓解率比较差异无统计学意义(P0.05),ERCP患者住院费用少于PTCD组患者,住院时间亦短于PTCD组患者(P0.05)。两组患者术后1 d、术后7 d丙氨酸转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)水平均较术前降低,且两组患者术后7 d上述指标水平低于术后1 d(P0.05),ERCP组术后1 d、术后7 d ALT、TBIL、DBIL水平与PTCD组比较差异无统计学意义(P0.05)。两组患者术后并发症总发生率比较差异无统计学意义(P0.05)。结论:PTCD、ERCP治疗结石性梗阻性黄疸,均能有效改善患者临床症状和肝功能,且手术安全性相当,但ERCP可明显减少住院时间和住院费用。

A Comparative Study of Percutaneous Transhepatic Biliary Drainage and Retrograde Cholangiopancreatography in the Treatment of Calculous Obstructive Jaundice

ABSTRACT Objective: To compare the efficacy of percutaneous transhepatic cholangiography (PTCD) and retrograde cholan- giopancreatography (ERCP) in the treatment of calculous obstructive jaundice. Methods: 80 patients with calculous obstructive jaundice who were admitted to the Oriental Hepatobiliary Surgery Hospital of the Third Affiliated Hospital of Naval Military Medical University from March 2016 to April 2018 were selected. The patients were divided into ERCP group (n=40, given ERCP) and PTCD group (n=40,given PTCD) according to different interventional procedures. The operation time, intraoperative bleeding volume, hospitalization ex- penses, hospitalization time, treatment success rate, jaundice remission rate and complications were recorded between the two groups, the liver function indexes of the two groups were compared before operation, 1 d after operation and 7 d after operation. Results: There were no significant differences between the two groups in operation time, intraoperative bleeding volume, treatment success rate and jaundice remission rate(P>0.05). The hospitalization expenses of ERCP patients were less than those of PTCD patients, and the hospitalization time was shorter than that of PTCD patients(P<0.05). The alanine aminotransferase (ALT), total bilirubin (tTBIL) and direct bilirubin (DBIL) were lower in the two groups at 1 d after operation, 7 d after operation than those before operation, and the above-mentioned in- dexes in the two groups at 7 d after operation were lower at 1d after operation(P<0.05). There was no significant difference in ALT, TBIL and DBIL levels between ERCP group and PTCD group at 1d and 7 d after operation(P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion: PTCD and ERCP can effectively improve the clinical symptoms and liver function of patients with calculous obstructive jaundice, and the safety of operation is quite similar. However, ERCP can significantly reduce hospitalization time and hospitalization costs.