【摘要】 目的比较经内镜逆行胰胆管造影(ERCP)途径与经皮经肝胆管引流(PTCD)途径胆管金属支架置入治疗恶性梗阻性黄疸的临床效果。方法选取2010年6月至2015年6月期间在我院行胆管金属支架置入治疗的梗阻性黄疸患者136例,其中经ERCP途径53例(ERCP组)中低位梗阻44例、高位梗阻9例,经PTCD途径83例(PTCD组)中低位梗阻24例、高位梗阻59例。比较2组的手术成功率、有效率、术后并发症发生率、住院时间及手术费用。结果①2组手术成功率:ERCP组和PTCD组手术总成功率比较差异无统计学意义(P>0.05),其中低位梗阻者在ERCP组和PTCD组间的手术成功率比较差异无统计学意义(P>0.05),而高位梗阻者在ERCP组的手术成功率明显低于PTCD组(P<0.05)。②2组临床疗效:ERCP组和PTCD组总有效率比较差异无统计学意义(P>0.05),其中低位梗阻者在ERCP组的总有效率明显高于PTCD组(P<0.05),而高位梗阻者在ERCP组的总有效率明显低于PTCD组(P<0.05)。③2组住院时间和住院费用:ERCP组的住院时间明显短于PTCD组(P<0.05),2组的住院费用比较差异无统计学意义(P>0.05)。④2组术后并发症情况:ERCP组总并发症发生率明显低于PTCD组(P<0.05),其中低位梗阻者在ERCP组的总并发症发生率明显低于PTCD组(P<0.05),而高位梗阻者在ERCP组的总并发症发生率明显高于PTCD组(P<0.05)。结论经ERCP和经PTCD途径胆管金属支架置入治疗梗阻性黄疸均可取得较好的临床疗效,对于低位梗阻患者而言经ERCP更有优势,对于高位梗阻患者而言经PTCD途径更有优势。更多还原

【Abstract】 Objective To compare clinical effect of biliary metallic stent implantation via endoscopic retrograde cholangiopancreatography(ERCP) and percutaneous transhepatic cholangial drainage(PTCD) approaches in treatment of malignant obstructive jaundice. Methods One hundred and thirty-six patients with malignant obstructive jaundice who received the biliary metallic stent implantation from June 2010 to June 2015 in this hospital were selected. There were 53 cases via ERCP approach(ERCP group), in which 44 patients with low malignant obstructive jaundice, 9 patients with high malignant obstructive jaundice. There were 83 cases via PTCD approach(PTCD group), in which 24 patients with low malignant obstructive jaundice, 59 patients with malignant obstructive jaundice. The surgical success rate, effective rate, incidence of postoperative complications, hospital stay, and hospitalization expenses were compared in these two groups. Results① The total surgical success rate had no significant difference between the ERCP group and the PTCD group(P>0.05). The surgical success rate of the patients with low malignant obstructive jaundice had no significant difference between the ERCP group and PTCD group(P>0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group(P<0.05).② The total effective rate had no significant difference between the ERCP group and PTCD group(P>0.05), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group(P<0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group(P<0.05).③ The hospital stay of the ERCP group was significantly shorter than that in the PTCD group(P<0.05). The hospitalization expenses had no significant difference between the ERCP group and PTCD group(P>0.05).④ The total incidence of complications in the ERCP group was significantly lower than that in the PTCD group(P<0.05), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group(P<0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group(P<0.05). Conclusions The biliary metallic stent implantation via ERCP and PTCD approaches in treatment of malignant obstructive jaundice could all obtain a better clinical efficacy. It has more advantages in patients with low malignant obstructive jaundice via ERCP approach and in the patients with high malignant obstructive jaundice via PTCD approach.更多还原