| Objective: Through retrospective analysis and comparison of the efficacy of ERCP and PTCD in the treatment of patients with malignant obstructive jaundice,it provides a reference for the clinical treatment of malignant obstructive jaundice.Methods: A retrospective analysis of 137 patients with malignant obstructive jaundice admitted to the Department of Hepatobiliary Surgery and Interventional Department of our hospital from January 2015 to June 2019 was treated with ERCP or PTCD and complete clinical data.According to different treatment methods,they were divided into ERCP Group(44 cases)and PTCD group(93 cases),comparing liver function changes,electrolyte changes,postoperative complications,postoperative hospital stay and so on.Statistical analysis was performed using SPSS 18.0 analysis software.Results: A total of 137 cases were collected in the two groups,including 44 cases in the ERCP group,27 males,17 females,28 cases of low biliary obstruction,16 cases of high biliary obstruction,including 12 cases of hilar cholangiocarcinoma,18 cases of pancreatic head cancer,and urinary tract 9 cases of peripheral abdominal cancer and lower common bile duct cancer,5 cases of malignant tumors or metastases of adjacent organs,with an average age of 66.82±8.97 years;93 cases in the PTCD group,including 59 males and 34 females,49 cases of low biliary obstruction,and high biliary obstruction Among 44 cases,43 cases of hilar cholangiocarcinoma,28 cases of pancreatic head cancer,13 cases of periampullary carcinoma and lower common bile duct cancer,9 cases of malignant tumor or metastatic carcinoma of adjacent organs,with an average age of 66.63 ± 11.67 years.There were no significant differences between the two groups in age,gender,liver function level,electrolytes,and obstruction sites(P>0.05).Changes in liver function before and after surgery in both groups of patients: postoperative serum total bilirubin and alanine aminotransferase were improved to varying degrees compared with before surgery,the difference was statistically significant(P<0.05).Postoperative serum total bilirubin andalanine aminotransferase were compared between the two groups,and the difference was not statistically significant(P>0.05).There was no significant difference in electrolyte changes between the two groups of patients before and after surgery,and the difference was not statistically significant(P>0.05).Two surgical methods were used to compare the degree of liver function improvement and yellowing effect before and after operation at different obstruction sites: in patients with high biliary obstruction,the decrease of alanyl aminotransferase in PTCD group was significantly higher than that in ERCP group,and the difference was statistically significant(P<0.05)),compared with the degree of decrease in serum total bilirubin,the difference was not statistically significant(P>0.05).Among patients with low biliary obstruction,there was no significant difference in the reduction of transaminase and total serum bilirubin between the PTCD group and the ERCP group before and after surgery,and the difference was not statistically significant(P>0.05).Postoperative complications: A total of 7 postoperative complications occurred in the ERCP group,with an incidence rate of 15.9%(7/44),including 3 cases of bleeding,2 cases of acute pancreatitis,and 2 cases of biliary tract infection.Both bleeding and biliary infection occurred In patients with high biliary obstruction,patients with acute pancreatitis complicated with acute biliary obstruction and low biliary obstruction in 1 case each.A total of 12 postoperative complications occurred in the PTCD group,with an incidence rate of 12.9%(12/93),including 3 cases of biliary tract hemorrhage,7 cases of biliary tract infection,and 2 cases of stent obstruction.Biliary tract bleeding occurred in patients with low biliary obstruction,high There were 2 cases of biliary tract infection and 1 case of stent obstruction in patients with biliary obstruction,and 5 cases of biliary tract infection and 1 case of stent obstruction in patients with low biliary obstruction.There was no statistical difference in the incidence of postoperative complications between the two groups(P>0.05).Average postoperative hospital stay: 5.0 days in the ERCP group and 7.0days in the PTCD group,which was statistically significant(P<0.05).Conclusion: For the palliative treatment of advanced malignant obstructive jaundice,in low biliary obstruction,ERCP and PTCD can effectively yellow and improve liver function,and the effect is the same.In high biliary obstruction,the two surgical methods have the same reduction Yellow effect,but the latter is better than the former in improving liver function.Postoperative hospital stay ERCP was slightly shorter than PTCD;there wasno significant difference in the incidence of postoperative complications between the two.For high biliary obstruction,PTCD treatment can be given priority. |
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