三种胆道外引流术治疗梗阻性黄疸的短期疗效及术后肝功能的影响

doi:10.3877/cma.j.issn.1674-3946.2020.05.021

目的

研究三种不同的胆道引流术对梗阻性黄疸的短期疗效及术后肝功能的影响。

方法

回顾性分析2016年7月至2019年6月收治的106例恶性梗阻性黄疸患者临床资料。按其治疗术式将其分为三组：ERCP组、PTCD组、EUS-BD组。采用统计软件SPSS 24.0进行数据处理。患者住院时间、肝功能指标等计量资料采用(±s)表示，三组组间比较采用单因素方差分析，组间两两比较采用LSD-t检验；术后并发症发生率采用χ²检验；以P<0.05为差异有统计学意义。

结果

三组患者均成功完成手术，术后各项临床症状均得以缓解。三组患者平均住院天数EUS-BD组<ERCP组<PTCD，差异有统计学意义(P<0.001)；术后7 d三组患者肝功能各项指标均明显下降，与术前相比，差异均有统计学意义(P<0.05)；ERCP组患者总缓解率为74.3%(26/35)，PTCD组及EUS-BD组分别为77.3%(34/44)、77.8%(21/27)差异无统计学意义(P>0.05)；ERCP组患者术后并发症发生率14.3%，PTCD组34.1%，EUS-BD组7.4%，差异有统计学意义(P＝0.013)。

结论

ERCP、PTCD及EUS-BD三种引流方式对于恶性梗阻性黄疸的短期疗效相当，其中EUS-BD并发症较少、恢复更快、优势更大。

关键词: 胰胆管造影术，内窥镜逆行, 经皮经肝穿刺胆道引流术, 超声内镜引导下胆道穿刺引流, 肝功能, 疗效比较研究

Objective

To study the short-term effect of three kinds of biliary drainage on obstructive jaundice and influence of postoperative liver function.

Methods

The clinical data of 106 patients with malignant obstructive jaundice from July 2016 to June 2019 were analyzed retrospectively. The patients were divided into three groups according to their treatment methods: ERCP group, PTCD group and EUS-BD group. The data were analyzed by SPSS24.0 statistical software. Among them, hospitalization time and liver function index were expressed by (±s). The data among three different groups were compared by one-way ANOVA, two different data in one group were compared by LSD-t test. The incidence of postoperative complications was compared by χ² test. P<0.05 was considered statistically significant.

Results

All the patients in the three groups completed the operation successfully, and all the clinical symptoms were relieved. The average hospitalization days of the three groups showed as: EUS-BD group<ERCP group<PTCD group (P<0.001). All indexes of liver function in the three groups decreased significantly on day 7 after surgery, and the differences were statistically significant compared with those before surgery (P<0.05). The total remission rate was 74.3% (26/35) in the ERCP group, 77.3% (34/44) in the PTCD group and 77.8% (21/27) in the EUS-BD group (P>0.05). The incidence of postoperative complications was 14.3% in the ERCP group, 34.1% in the PTCD group, and 7.4% in the EUS-BD group, with statistically significant differences (P=0.013).

Conclusion

ERCP, PTCD and EUS-BD drainage have the same short-term therapeutic effect on malignant obstructive jaundice, while EUS-BD has less complications, faster recovery and greater advantages.

Key words: Cholangiopancreatography, endoscopic retrograde, PTCD, EUS-BD, Liver function, Comparative effectiveness research

表1 106例恶性梗阻性黄疸患者不同引流术式三组基本临床资料比较[(±s)，例]

组别	例	性别(男/女)	年龄(岁)	病因(A/B/C/D/E)
ERCP组	35	21/14	67.2±10.4	9/12/8/4/2
PTCD组	44	28/16	70.3±9.7	12/14/11/4/3
EUS-BD组	27	18/9	68.6±8.9	7/9/8/2/1
F/χ²	-	0.297	0.977	0.897
P	-	0.861	0.372	0.999

表1 106例恶性梗阻性黄疸患者不同引流术式三组基本临床资料比较[(±s)，例]

组别	例	性别(男/女)	年龄(岁)	病因(A/B/C/D/E)
ERCP组	35	21/14	67.2±10.4	9/12/8/4/2
PTCD组	44	28/16	70.3±9.7	12/14/11/4/3
EUS-BD组	27	18/9	68.6±8.9	7/9/8/2/1
F/χ²	-	0.297	0.977	0.897
P	-	0.861	0.372	0.999

表2 106例恶性梗阻性黄疸患者不同引流术式三组患者术后7 d肝功能变化(±s)

组别	例数	时间	ALT(U/L)	TBIL( mol/L)
ERCP组	35	术前	207.6±94.1	186.4±89.6
?	?	术后7 d	93.2±42.7^a	89.4±50.7^a
PTCD组	44	术前	213.4±102.3	183.2±92.1
?	?	术后7 d	102.5±59.6^a	92.3±45.4^a
EUS-BD组	27	术前	198.7±98.7	201.3±98.5
?	?	术后7 d	92.5±45.3^a	94.4±51.6^a
组别	例数	时间	DBIL( mol/L)	AKP(U/L)
ERCP组	35	术前	192.1±79.6	398.7±132.4
?	?	术后7 d	91.2±51.4^a	231.4±94.6^a
PTCD组	44	术前	187.5±81.6	379.5±122.7
?	?	术后7 d	89.6±49.5^a	203.9±97.3^a
EUS-BD组	27	术前	186.4±82.7	402.6±187.1
?	?	术后7 d	84.4±54.3^a	211.4±91.7^a
组别	例数	时间	GGT(U/L)
ERCP组	35	术前	712.4±155.9
?	?	术后7 d	342.4±102.6^a
PTCD组	44	术前	731.7±168.5
?	?	术后7 d	336.8±111.5^a
EUS-BD组	27	术前	728.6±159.4
?	?	术后7 d	326.5±121.4^a

表2 106例恶性梗阻性黄疸患者不同引流术式三组患者术后7 d肝功能变化(±s)

组别	例数	时间	ALT(U/L)	TBIL( mol/L)
ERCP组	35	术前	207.6±94.1	186.4±89.6
?	?	术后7 d	93.2±42.7^a	89.4±50.7^a
PTCD组	44	术前	213.4±102.3	183.2±92.1
?	?	术后7 d	102.5±59.6^a	92.3±45.4^a
EUS-BD组	27	术前	198.7±98.7	201.3±98.5
?	?	术后7 d	92.5±45.3^a	94.4±51.6^a
组别	例数	时间	DBIL( mol/L)	AKP(U/L)
ERCP组	35	术前	192.1±79.6	398.7±132.4
?	?	术后7 d	91.2±51.4^a	231.4±94.6^a
PTCD组	44	术前	187.5±81.6	379.5±122.7
?	?	术后7 d	89.6±49.5^a	203.9±97.3^a
EUS-BD组	27	术前	186.4±82.7	402.6±187.1
?	?	术后7 d	84.4±54.3^a	211.4±91.7^a
组别	例数	时间	GGT(U/L)
ERCP组	35	术前	712.4±155.9
?	?	术后7 d	342.4±102.6^a
PTCD组	44	术前	731.7±168.5
?	?	术后7 d	336.8±111.5^a
EUS-BD组	27	术前	728.6±159.4
?	?	术后7 d	326.5±121.4^a

表3 106例恶性梗阻性黄疸患者不同引流术式三组患者术后并发症发生情况(例)

组别	例数	胆道感染	胰腺炎	胆瘘	出血	导管相关	总发生率(%)
ERCP组	35	2	2	1	0	0	5(14.3)
PTCD组	44	6	2	1	2	4	15(34.1)
EUS-BD组	27	1	1	0	0	0	2(7.4)
χ²	?	?	?	?	?	?	8.573
P	?	?	?	?	?	?	0.013

表3 106例恶性梗阻性黄疸患者不同引流术式三组患者术后并发症发生情况(例)

组别	例数	胆道感染	胰腺炎	胆瘘	出血	导管相关	总发生率(%)
ERCP组	35	2	2	1	0	0	5(14.3)
PTCD组	44	6	2	1	2	4	15(34.1)
EUS-BD组	27	1	1	0	0	0	2(7.4)
χ²	?	?	?	?	?	?	8.573
P	?	?	?	?	?	?	0.013

[1]	Gravito-Soares E，Gravito-Soares M，Gomes D，et al.Clinical applicability of Tokyo guidelines 2018/2013 in diagnosis and severity evaluation of acute cholangitis and determination of a new severity model[J]．Scand J Gastroenterol，2018，53(3):329-334.
[2]	Kurniawan J，Hasan I，Gani RA，et al.Mortality-related Factors in Patients with Malignant Obstructive Jaundice[J]．Acta Med Indones，2016，48(4):282-288.
[3]	Pavlidis ET，Pavlidis TE.Pathophysiological consequences of obstructive jaundice and perioperative management[J]．Hepatobiliary Pancreat Dis Int，2018，17(1):17-21.
[4]	Martínez-Cecilia D，Reyes-Díaz M，Ruiz-Rabelo J，et al.Oxidative stress influence on renal dysfunction in patients with obstructive jaundice：a case and control prospective study[J]．Redox Biol，2016，8:160-164.
[5]	Wilcox CM，Kim H，Seay T，et al.Choice of plastic or metal stent for patients with jaundice with pancreaticobiliary malignancy using simple clinical tools：a prospective evaluation[J]．BMJ Open Gastroenterol，2015，2(1):e000014.
[6]	Liu Q，Li BS，Song YJ，et al.Hydrogen-rich saline protects against mitochondrial dysfunction and apoptosis in mice with obstructive jaundice[J]．Mol Med Rep，2016，13(4):3588-3596.
[7]	Yasuda I，Doi S，Mabuchi M．Recent advances of biliary drainage for malignant biliary obstruction[J]．Nihon Rinsho，2015，73(Suppl 3):819-822.
[8]	Tol JAMG，van Hooft JE，Timmer R，et al.Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer[J]．Gut，2016，65(12):1981-1987.
[9]	Song TJ，Lee JH，Lee SS，et al.Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection[J]．Gastrointest Endosc，2016，84(5):814-821.
[10]	Lee PJ，Podugu A，Wu D，et al.Preoperative biliary drainage in resectable pancreatic cancer：a systematic review and network meta-analysis[J]．HPB(Oxford)，2018，20(6):477-486.
[11]	Liu JG，Wu J，Wang J，et al.Endoscopic biliary drainage versus percutaneous transhepatic biliary drainage in patients with resectable hilar cholangiocarcinoma：a systematic review and meta-analysis[J]．J Laparoendosc Adv Surg Tech A，2018，28(9):1053-1060.
[12]	Togawa O，Isayama H，Kawakami H，et al.Preoperative biliary drainage using a fully covered self-expandable metallic stent for pancreatic head cancer: A prospective feasibility study[J]．Saudi J Gastroenterol，2018，24(3):151-156.
[13]	Park JK, Woo YS, Noh DH，et al.Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction：prospective randomized controlled study[J]．Gastrointest Endosc，2018，88(2):277-282.
[14]	Sharaiha RZ，Khan MA，Kamal F，et al.Efficacy and safety of EUS-guided biliary drainage in compaison with percutaneous biliary drainage when ERCP fails：a systematic review and meta-analysis[J]．Gastrointest Endosc，2017，85(5):904-914.
[15]	Moole H，Bechtold ML，Forcione D，et al. A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP[J]．Medicine(Baltimore)，2017，96(3):e5154.
[16]	Baars JE，Kaffes AJ，Saxena P．EUS-guided biliary drainage：A comprehensive review of the literature[J]．Endosc Ultrasound，2018，7(1):4-9.

[1]	陈镁仪, 李伊尧, 张梦圆, 许杰, 马若凡, 李登, 顾菁. 图示化自主髋关节功能评分系统的应用研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 320-328.
[2]	邵小丽, 林燕, 张玲玲, 韩亚琴. 超声引导下子宫肌瘤注射聚桂醇硬化术联合术后米非司酮治疗临床疗效分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 353-360.
[3]	苏永涛, 王春雷, 徐广琪, 关中正, 焦伟, 隋颖. 胫骨骨膜牵张术联合富血小板血浆对治疗糖尿病足溃疡的疗效观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(03): 238-244.
[4]	李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[5]	马立伟, 贾志强, 陈午盛, 邵明亮, 刘琼, 段玉松. CalliSpheres载药微球联合碘化油治疗肝癌的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 369-372.
[6]	刘炯, 彭乐, 马伟, 江斌. 鞘外解剖肝蒂技术治疗肝内胆管细胞癌的疗效评估[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 373-376.
[7]	陈燕. LCBDE和ERCP+EST治疗胆囊结石合并胆总管结石的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 385-388.
[8]	谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[9]	关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[10]	吴警, 吐尔洪江·吐逊, 温浩. 肝切除术前肝功能评估新进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 889-893.
[11]	傅斌生, 冯啸, 杨卿, 曾凯宁, 姚嘉, 唐晖, 刘剑戎, 魏绪霞, 易慧敏, 易述红, 陈规划, 杨扬. 脂肪变性供肝在成人劈离式肝移植中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 789-794.
[12]	伍细蓉, 徐立文, 陈亚琼. 基于LPR和FARI构建肝衰竭患者生存预后模型[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 675-681.
[13]	黄金鑫, 陈佳骏, 王旋, 曲岩, 张晞文, 李甫. ERCP在胆胰合流异常患者诊治中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 699-704.
[14]	钟造茂, 罗文超, 蔡满航, 陈显育, 钟跃思. 肝癌肝切除术后肝衰竭的危险因素分析及列线图模型构建[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 289-295.
[15]	刘建勇, 杨芳, 吕立志, 江艺, 蔡秋程. 肝移植治疗Ⅳ级肝昏迷疗效及其影响因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 344-349.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The short-term effect of three kinds of biliary drainage on obstructive jaundice and influence of postoperative liver function

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The short-term effect of three kinds of biliary drainage on obstructive jaundice and influence of postoperative liver function