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

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

Abstract

Abstract:

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

Yu Cai, Pu Yan, Wu Jun Li, Xiaowei Chang, Huan Jia, Lin Yang. The short-term effect of three kinds of biliary drainage on obstructive jaundice and influence of postoperative liver function[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 504-507.

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References 16

[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.

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

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

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

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

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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