ERCP与PTCD对局部晚期或转移性胰腺癌合并恶性梗阻性黄疸患者姑息性化疗启动时间的影响

Impact of ERCP versus PTCD on time to initiation of palliative chemotherapy in patients with locally advanced or metastatic pancreatic cancer with malignant obstructive jaundice

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）与经皮经肝胆管穿刺引流术（PTCD）对局部晚期或转移性胰腺癌合并恶性梗阻性黄疸（MOJ）患者姑息性化疗启动时间的影响。方法 回顾性分析2021年1月－2025年4月两家医院收治并确诊为局部晚期或转移性胰腺癌合并MOJ的58例患者的临床资料。其中，绍兴市上虞人民医院12例，山东省立第三医院46例。按照治疗方法不同，分为ERCP组（n = 35）和PTCD组（n = 23）。分析两组患者梗阻性黄疸病程、总胆红素降至 ≤ 1.8 mg/dL（目标事件Ⅰ）及 ≤ 2.5 mg/dL（目标事件Ⅱ）和 ≤ 5.0 mg/dL（目标事件Ⅲ）的时间、姑息化疗情况、化疗方案和并发症发生率等。结果 两组患者手术干预后总胆红素持续下降，ERCP组下降速度较PTCD组快［总胆红素中位数为2.0（1.4，2.9）mg/dL和2.8（1.9，4.1）mg/dL］，差异有统计学意义（P < 0.05）。两组患者达到目标事件Ⅰ和目标事件Ⅱ的占比比较，差异均无统计学意义（P > 0.05）；ERCP组达到目标事件Ⅲ的占比明显高于PTCD组，差异有统计学意义（P = 0.015）。58例患者中，共79.31%（46/58）的患者在肿瘤治疗期间接受了姑息性化疗。其中，41.30%（19/46）的患者使用吉西他滨单药的标准治疗方案。两组患者并发症发生率比较，差异无统计学意义（P = 0.138）。结论 ERCP和PTCD均是降低MOJ患者总胆红素的有效治疗方法，并发症发生率相当。但ERCP可更快地降低血清总胆红素，以便更早地启动姑息性化疗，延长患者生存时间。

Abstract:

Objective Investigating the impact of endoscopic retrograde cholangiopancreatography (ERCP) versus percutaneous transhepatic cholangial drainage (PTCD) on time to initiation of palliative chemotherapy in patients with locally advanced or metastatic pancreatic cancer with malignant obstructive jaundice (MOJ).Methods Retrospective analysis of clinical data from patients with locally advanced or metastatic pancreatic cancer complicated by MOJ treated at two hospitals between January 2021 and April 2025: a total of 58 cases including 12 from Shangyu People’s Hospital of Shaoxing and 46 from Shandong Provincial Third Hospital were divided into the ERCP group (n = 35) and PTCD group (n = 23) according to different treatment methods. The study analyzed the duration of obstructive jaundice, time to achieve target events (Event I: total bilirubin ≤ 1.8 mg/dL; Event II: ≤ 2.5 mg/dL; Event III: ≤ 5.0 mg/dL), palliative chemotherapy status, chemotherapy regimens, and incidence of complications between the two groups.Results Postoperative total bilirubin levels continued to decrease in both groups, with a faster rate of decrease observed in the ERCP group compared to the PTCD group [median total bilirubin: 2.0 (1.4，2.9) mg/dL and 2.8 (1.9，4.1) mg/dL], the difference was statistically significant (P < 0.05). There were no statistically significant differences in the proportions of patients achieving target event I and target event II between the two groups (P > 0.05). However, the proportion of patients achieving target event III was significantly higher in the ERCP group compared to the PTCD group, with a statistically significant difference (P = 0.015). Overall, 79.31% (46/58) of patients received palliative chemotherapy during tumor treatment and 41.30% (19/46) of patients were treated with gemcitabine monotherapy as the standard treatment regimen. No statistically significant difference was observed in the incidence of complications between the two groups (P = 0.138).Conclusion Both ERCP and PTCD are effective therapeutic modalities for reducing total bilirubin levels in patients with MOJ, with comparable complication rates. However, ERCP enables faster reduction of total bilirubin, thereby facilitating earlier initiation of palliative chemotherapy and prolonging survival.