Effect of different operation methods on malignant obstructive jaundice and its influence on immune function

doi:10.3877/cma.j.issn.1674-3946.2024.02.017

Abstract

Abstract:

Objective

To explore the therapeutic effect of endoscopic retrograde cholangiopancreatography (ERCP) biliary stent implantation and percutaneous hepatic puncture biliary drainage (PTCD) on malignant obstructive jaundice (MOJ) and its influence on immune function.

Methods

The data of 117 patients with MOJ from January 2021 to December 2022 were retrospectively analyzed and divided into two groups according to different operation methods: ERCP group (ERCP biliary stent implantation, n=58) and PTCD group (PTCD treatment, n=59). SPSS 19.0 software was used to analyze the data, and independent sample t test was used for measurement data such as surgical indicators, liver function and immune function. The statistical data of obstruction type, clinical efficacy, complications, etc. were shown as [example (%)], and χ² test or Rank Sum test were used. P<0.05 was considered statistically significant.

Results

On the 7th day after operation, the effective rate of low obstruction in ERCP group (92.7%) was higher than that in PTCD group (69.2%), and the effective rate of high obstruction in ERCP group (70.0%) was lower than that in PTCD group (90.9%) (P <0.05). The levels of direct bilirubin (DBIL), adenosine deaminase (ADA), alkaline phosphatase (ALP) and glutamyltransferase (GGT) in 2 groups were lower than before surgery, and those in PTCD group were lower than those in ERCP group (all P <0.05). The levels of T lymphocyte subsets (CD3+, CD4+, CD4+/CD8+) in ERCP group were lower than those in PTCD group (P <0.05).

Conclusion

Both ERCP biliary stent implantation and PTCD can effectively treat MOJ and improve liver function and immune function of patients. However, PTCD is more suitable for high MOJ, and ERCP biliary stent implantation is more suitable for low MOJ.

Key words: Malignant Obstructive Jaundice, Cholangiopancreatography, Endoscopic Retrograde, Percutaneous Transhepaticcholangial Drainage, Immune Function, Comparative Effectiveness Research

Xin Lu, Qin Yang, Jiayi Xu. Effect of different operation methods on malignant obstructive jaundice and its influence on immune function[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(02): 180-183.

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References 15

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组别	例数	性别（例）	年龄（岁，）	梗阻类型（例）	病因（例）
组别	例数	男/女	年龄（岁，）	A/B	C/D/E/F
ERCP组	58	37/21	60.2±5.4	28/30	23/15/11/9
PTCD组	59	34/25	60.5±5.4	26/33	20/18/14/7
χ²/t值		0.466	0.270	0.208	1.084
P值		0.495	0.788	0.648	0.781

组别	例数	性别（例）	年龄（岁，）	梗阻类型（例）	病因（例）
组别	例数	男/女	年龄（岁，）	A/B	C/D/E/F
ERCP组	58	37/21	60.2±5.4	28/30	23/15/11/9
PTCD组	59	34/25	60.5±5.4	26/33	20/18/14/7
χ²/t值		0.466	0.270	0.208	1.084
P值		0.495	0.788	0.648	0.781

组别	例数	手术时间(min)	术中出血量(ml)	首次下床时间(d)	住院时间(d)
ERCP组	58	75.16±7.39	78.94±8.76	3.65±0.51	12.35±2.73
PTCD组	59	77.28±7.65	80.63±9.14	4.17±0.64	15.44±3.26
t值		1.524	1.021	4.855	5.562
P值		0.130	0.310	<0.001	<0.001

组别	例数	手术时间(min)	术中出血量(ml)	首次下床时间(d)	住院时间(d)
ERCP组	58	75.16±7.39	78.94±8.76	3.65±0.51	12.35±2.73
PTCD组	59	77.28±7.65	80.63±9.14	4.17±0.64	15.44±3.26
t值		1.524	1.021	4.855	5.562
P值		0.130	0.310	<0.001	<0.001

组别	例数	梗阻类型		总有效
组别	例数	低位梗阻	高位梗阻	总有效
ERCP组	58	92.9(26/28)	70.0(21/30)	47(81.0)
PTCD组	59	69.2(18/26)	90.9(30/33)	48(81.4)
χ²值		4.987	4.455	0.002
P值		0.026	0.035	0.965

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