摘要
目的 观察经内镜逆行性胰胆管造影术（ERCP）植入胆道支架与经皮经肝胆道穿刺术（PTCD）在治疗恶性阻塞性黄疸（MOJ）中的临床效果.方法 选取我院2013年1月至2016年3月收治的88例MOJ患者,按照随机数字表法分为ERCP组和PTCD组,各44例,ERCP组经ERCP途径植入胆道支架,PTCD组行经皮经肝胆道穿刺术,对比两组患者手术成功率、临床疗效、肝功能及并发症发生率.结果 ERCP组成功率为93.18%（41/44）,PTCD组成功率为90.91%（40/44）,组间比较差异无统计学意义（P〉0.05）;临床疗效方面,ERCP组临床总有效率为92.68%（38/41）,PTCD组总有效率为90.00%（36/40）,组间比较差异无统计学意义（P〉0.05）;ERCP组低位梗阻有效率明显高于PTCD组（100.00%与75.00%）,PTCD组高位梗阻有效率明显高于ERCP组（96.43%与83.33%）,组间比较差异均有统计学意义（χ2值分别为3.503、2.771;P均〈0.05）;治疗后肝功能恢复方面,ERCP组低位梗阻患者肝功能指标均优于高位梗阻患者,PTCD组高位梗阻患者肝功能指标均优于低位梗阻患者,差异均有统计学意义（P均〈0.05）;ERCP组并发症发生率为11.36%,PTCD组并发症发生率为15.91%,比较差异无统计学意义（P〉0.05）.结论 经ERCP途径与PTCD途径植入胆道支架均具有良好的临床疗效,但相比而言,低位梗阻ERCP途径更佳,高位梗阻PTCD途径更佳,临床治疗过程中需根据患者不同梗阻部位选择相应的手术途径,以期取得最佳的治疗效果.
Objective To observe the clinical effect of endoscopic retrograde cholangiopancreatography （ERCP）biliary stent implantation and percutaneous transhepatic cholangiography（PTCD）in the treatment of malignant obstructive jaundice（MOJ）.Methods Eighty-eight patients with MOJ treated in the Second Affiliated Hospital of Hainan Medical University from January 2013 to March 2016 were selected and then randomly divided into ERCP group and PTCD group,44 cases in each group.ERCP group received biliary tract stent implantation via ERCP pathway, and PTCD group underwent percutaneous transhepatic biliary puncture.The success rate,clinical efficacy,liver function and complication rate of the two groups were compared.Results The success rate of ERCP group was 93.18%（41/44）,and the success rate of PTCD group was 90.91%（40/44）.There was no significant difference between the two groups（P〉0.05）.In terms of the clinical curative effect,the total effective rate of ERCP group was 92.68%（38/41）,the total effective rate of PTCD group was 90.00%（36/40）,there was no significant difference between the two groups（P〉0.05）;the low obstruction efficiency in ERCP group was significantly higher than that of PTCD group（100.00%vs.75%）,the high obstruction efficiency in ERCP group was significantly higher than that of PTCD group （96.43% vs.83.33%）,the differences between the groups were statistically significant（χ2=3.503,2.771,P〈0.05）;in terms of the liver function recovery after treatment,the liver function index of patients with low obstruction in ERCP group were better than that in patients with high obstruction,while in PTCD group,patients with high obstructive had better liver function,compared to the low obstruction patients,the differences were statistically significant（P〈0.05）; the complication rate in ERCP group and PTCD group were11.36% and 15.91%,the difference was not statistically significant（P〉0.05）.Conclusion The ERCP pathway and PTCD pathway implantation of biliary metal stent have great clinical efficacy,while in comparison,ERCP pathway performs better in low obstruction and PTCD pathway was more suitable in high obstruction.In the course of clinical treatment,the selection of surgical approach should be based on the different obstruction sites of the patients,so as to obtain the best therapeutic effect.
出处
《中国综合临床》
2017年第11期1030-1034,共5页
Clinical Medicine of China
