PTCD与ENBD对恶性梗阻性黄疸术前减黄效果的临床比较
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摘要
目的对比分析经皮肝穿刺胆道引流(PTCD)与经内镜鼻胆管引流(ENBD)对胆总管恶性梗阻性黄疸减黄的临床疗效。方法回顾性分析东方肝胆外科医院2016年8月至2018年3月收治的77例胆总管恶性梗阻患者临床资料,其中采取PTCD减黄41例(PTCD组)、采取ENBD减黄36例(ENBD组),对比分析两组患者操作治疗费用、临床疗效、术后并发症发生率。结果治疗前两组患者一般资料均无统计学差异(P>0.05)。进行减黄时PTCD组和ENBD组操作治疗耗材费用分别为(2 943.6±412.5)元和(5 792.2±312.2)元,差异有统计学意义(t=34.404,P<0.05)。总体来说,治疗后PTCD组胆汁引流量高于ENBD组(F=58.613,P<0.05),PTCD组血清总胆红素(F=12.8,P<0.05)、γ-谷氨酰转肽酶(F=5.214,P<0.05)、谷丙转氨酶(F=5.724,P<0.05)水平均低于ENBD组。结论 PTCD与ENBD用于胆总管恶性梗阻性黄疸术前减黄均能取得较好临床效果,但PTCD操作费用更少、效果更好。
Objective To compare the clinical effects of preoperative reduction jaundice by percutaneous transhepatic cholangial drainage(PTCD) and endoscopic nasobiliary drainage(ENBD) for choledochal malignant obstructive jaundice. Methods A total of 77 cases with choledochal malignant obstructive jaundice admitted in Eastern Hepatobiliary Surgery Hospital from Aug. 2016 to Mar. 2018 were retrospectively analyzed. Patients were divided into two groups, 41 cases received PTCD(PTCD group), and 36 cases received ENBD(ENBD group). The operation costs, clinical effects and postoperative complication incidences were compared between two groups. Results There was no significant difference on general information before treatment(P>0.05).The operation costs in PTCD group and ERCP group were(2 943.6±412.5) yuan and(5 792.2±312.2) yuan respectively, and the difference was statistically significant(t=34.404, P<0.05). The amount of bile drained in PTCD group was more than ENBD group(F=58.613, P<0.05). The levels of serum bilirubin, gamma glutamate transpeptidase and glutamate transaminase in PTCD group were all lower than those in ENBD group(F=12.8,P<0.05; F=5.214, P<0.05; F=5.724, P<0.05). Conclusion For patients with choledochal malignant obstructive jaundice, both PTCD and ENBD can obtain good clinical effect of the preoperative jaundice reduction. And PTCD approach can obtain better result and lower operation cost.
Objective To compare the clinical effects of preoperative reduction jaundice by percutaneous transhepatic cholangial drainage(PTCD) and endoscopic nasobiliary drainage(ENBD) for choledochal malignant obstructive jaundice. Methods A total of 77 cases with choledochal malignant obstructive jaundice admitted in Eastern Hepatobiliary Surgery Hospital from Aug. 2016 to Mar. 2018 were retrospectively analyzed. Patients were divided into two groups, 41 cases received PTCD(PTCD group), and 36 cases received ENBD(ENBD group). The operation costs, clinical effects and postoperative complication incidences were compared between two groups. Results There was no significant difference on general information before treatment(P>0.05).The operation costs in PTCD group and ERCP group were(2 943.6±412.5) yuan and(5 792.2±312.2) yuan respectively, and the difference was statistically significant(t=34.404, P<0.05). The amount of bile drained in PTCD group was more than ENBD group(F=58.613, P<0.05). The levels of serum bilirubin, gamma glutamate transpeptidase and glutamate transaminase in PTCD group were all lower than those in ENBD group(F=12.8,P<0.05; F=5.214, P<0.05; F=5.724, P<0.05). Conclusion For patients with choledochal malignant obstructive jaundice, both PTCD and ENBD can obtain good clinical effect of the preoperative jaundice reduction. And PTCD approach can obtain better result and lower operation cost.
引文
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[2]蒋孙路,黄强,翟东升.经内镜逆行胰胆管造影术和经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸的疗效对比[J].中国内镜杂志,2018,24(1):75-79.
[3]潘步建,宋洪亮,贺亚东,等.经皮胆道金属支架置入术治疗恶性梗阻性黄疸的疗效分析[J].中华肝胆外科杂志,2011,17(2):166-167.
[4]李明,郝芳,秦鸣放.超声内镜辅助治疗恶性梗阻性黄疸105例[J].世界华人消化杂志,2014,22(5):685-689.
[5]Zhang GQ,Li Y,Ren YP,et al.Outcomes of preoperativeendoscopic nasobiliarydrainage and endoscopicretrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy[J].World J Gastroenterol,2017,23(29):5386-5394.
[6]Nakai Y,Yamamoto R,Matsuyama M,et al.Multicenter study of endoscopic preoperative biliary drainage for malignant hilar biliary obstruction:E-POD hilar study[J].J Gastroenterol Hepatol,2018,33(5):1146-1153.
[7]王晨,刘江文,王忠敏,等.经皮肝胆管引流术在肝门部恶性肿瘤胆道梗阻中的应用[J].局解手术学杂志,2017,26(4):278-281.
[8]刘庚,王剑雄,孔棣.两种胆道引流术治疗肝门部胆管癌所致黄疸的疗效观察[J].中国中西医结合外科杂志,2013,19(3):237-240.
[9]刘献民.PTCD在老年恶性梗阻性黄疸ERCP操作失败患者中的疗效观察[J].肝胆胰外科杂志,2018,30(3):207-210.
[10]Zarzavadjian Le Bian A,Fuks D,Dalla Valle R,et al.Effectiveness and risk of biliary drainage prior to pancreatoduodenectomy:review of current status[J].Surg Today,2018,48(4):371-379.
[11]顾天翊,陆伦根.胆汁淤积性肝病的“上升”病理生理学模式[J].肝脏,2017,22(6):493-495.