两种方法联合胆道自膨式金属支架置入术治疗梗阻性黄疸的疗效对比

Comparison of therapeutic effects of two methods combined with self-expanding metal stent in treatment of obstructive jaundice

摘要:

目的 比较经皮肝穿刺胆道引流（PTCD）或内镜逆行胰胆管造影术（ERCP）联合胆道自膨式金属支架（SEMS）置入术治疗梗阻性黄疸（OJ）的疗效。方法 选取2022年1月－2023年7月该院收治的OJ患者125例，根据治疗方案不同分为对照组（62例采用PTCD联合胆道SEMS置入术）和研究组（63例采用ERCP联合胆道SEMS置入术）。比较黄疸缓解率、肝功能、细胞免疫功能和并发症发生情况。结果 研究组的黄疸缓解率为90.48%（57/63），与对照组的87.10%（54/62）比较，差异无统计学意义（P > 0.05）。治疗后，研究组的6项肝功能指标低于对照组，3项细胞免疫功能指标高于对照组，差异均有统计学意义（P < 0.05）。研究组并发症总发生率为9.52%（6/63），与对照组的12.90%（8/62）比较，差异无统计学意义（P > 0.05）。结论 ERCP联合胆道SEMS置入术，在改善肝功能和增强细胞免疫功能方面，均优于PTCD联合胆道SEMS置入术，黄疸缓解率和并发症发生率与PTCD联合胆道SEMS置入术并无差异。

Abstract:

Objective To compare the efficacy of percutaneous transhepatic cholangial drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) combined with self-expanding metal stent (SEMS) in treatment of obstructive jaundice (OJ).Methods From January 2022 to July 2023, 125 OJ patients were selected and grouped into two groups based on treatment plans. The reference group consisted of 62 cases who underwent PTCD combined with biliary SEMS implantation, while the test group consisted of 63 cases who underwent ERCP combined with biliary SEMS implantation. The remission rate of jaundice, liver function, cellular immune function, and complications were compared.Results There was no statistically significant difference in the relief rate of jaundice between the test group (90.48%, 57/63) and the reference group (87.10%, 54/62) (P > 0.05). After treatment, six measures of liver function in the test group were lower than those in the reference group, three indexes of cellular immune function in the test group were higher than those in the reference group, the differences were significant (P < 0.05). The total incidence of complications in the test group (9.52%, 6/63) showed no statistically significant difference compared to the reference group (12.90%, 8/62) (P > 0.05).Conclusion ERCP combined with biliary SEMS implantation is superior to PTCD combined with biliary SEMS implantation in improving liver function and enhancing cellular immune function, and there is no difference in jaundice relief rate and incidence of complications compared to PTCD combined with biliary SEMS implantation.