Study On Etiology And Clinical Diagnosis And Treatment Of Obstructive Jaundice

Objective: To investigate the etiology,diagnosis,treatment and prognosis of obstructive jaundice.Methods: The clinical data of 176 patients with obstructive jaundice admitted in our hospital from January 2013 to January 2016 were analyzed retrospectively.All patients underwent color Doppler ultrasound,CT,ERCP,MRCP and other two or more imaging studies,of which 108 cases of malignant obstructive jaundice,68 cases of benign obstructive jaundice.All patients underwent chat blood biochemical and tumor markers monitoring,a clear diagnosis of obstructive jaundice.In this study,85 patients underwent ERCP,60 underwent percutaneous transhepatic biliary drainage(PTCD),2 underwent PTCD without ERCP,13 underwent surgery,and 1 underwent IVC Intraoperative,15 patients were treated with conservative drugs.176 patients,25 patients were discharged,91 cases improved,53 cases of significant effect,7 deaths.Result:(1)Of the 176 patients with obstructive jaundice,68(38.64%)were malignant and 108(61.36%)were benign.The majority of pancreatic cancer was benign(37.24%),59 cases,86.76%)(2)Serum bilirubin levels in 176 patients with obstructive jaundice were significantly higher than those in patients with benign obstructive jaundice(P <0.01),and serum ALP levels in malignant obstructive jaundice patients were significantly higher than those in patients with benign obstructive jaundice In patients with benign obstructive jaundice(p <0.05)(3)The serum CA199 of malignant obstructive jaundice was significantly higher than that of benign obstructive jaundice(P <0.01).The serum CA199 of patients with malignant obstructive jaundice after ERCP was decreased(p <0.05),and benign obstructive jaundice After treatment,serum CA199 decreased significantly(p <0.001).The serum total bilirubin levels were significantly lower in patients with malignant obstructive jaundice(p <0.001)and significantly lower in patients with benign obstructive jaundice(p <0.001).(4)The effective rate of benign obstructive jaundice(97.87%)was significantly higher than that of malignant obstructive jaundice(63.41%)(P <0.001).(5)There was no significant difference in the success rate of PTCD and ERCP between the two groups(p> 0.05),but the complication rate of PTCD was higher than that of ERCP group(p <0.05)(P <0.05),while serum bilirubin levels decreased and serum CA199 levels were not significantly decreased in malignant patients.(6)benign obstructive jaundice malignant obstructive jaundice intervention surgery results,prognosis and prognosis is better(p <0.05).(7)PTCD and ERCP were the main methods to treat obstructive jaundice,the success rate of the two methods was similar(p> 0.05).(8)Compared with PTCD group,the average treatment cost and average treatment time of ERCP group were lower than those of PTCD group(p <0.05),while ERCP was higher than PTCD group(p <0.05),the average treatment cost was higher than PTCD group(p < 0.05).Conclusion:(1)obstructive jaundice is given priority to with malignant obstructive jaundice,benign obstructive jaundice in the majority with cholelith disease,malignant obstructive jaundice in the majority with pancreatic cancer(2)in patients with malignant obstructive jaundice serum bilirubin level and serum CA-199 level obviously higher than that of benign patients,patients with benign obstruction after ERCP and PTCD treatment serum bilirubin and CA199 were significantly decreased,and the patients with malignant serum bilirubin declined and declined serum CA199 level is not obvious.(3)benign obstructive jaundice than surgical operation in treating malignant obstructive jaundice intervention effect,better outcome and prognosis.(4)PTCD and ERCP become the main means of treatment of obstructive jaundice,two methods of operation success rate is quite;ERCP group,the average cost of treatment,average number of days of treatment group were lower than PTCD,and simple surgery than PTCD group.Compared with PTCD,preferred ERCP as the treatment of obstructive jaundice.