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

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

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