经皮经肝胆管引流术（PTCD）和内镜逆行胰胆管造影术（ERCP）治疗姑息性引流和术前胆道引流恶性梗阻性黄疸（MOJ）的疗效分析：单中心回顾性研究。
Analysis of the efficacy of Percutaneous Transhepatic Cholangiography Drainage (PTCD) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in the treatment of Malignant Obstructive Jaundice (MOJ) in palliative drainage and preoperative biliary drainage: a single-center retrospective study.
机构信息
Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Fenglin Road, Xuhui District, Shanghai, 200032, No, China.
出版信息
BMC Surg. 2024 Oct 12;24(1):307. doi: 10.1186/s12893-024-02595-w.
PURPOSE
This study aimed to assess the safety and efficacy of percutaneous transhepatic cholangiography drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) in palliative drainage and preoperative biliary drainage for treating malignant obstructive jaundice (MOJ).
METHODS
A total of 520 patients with MOJ who underwent PTCD or ERCP were enrolled and classified into palliative drainage group and preoperative biliary drainage group. Baseline characteristics, liver function, blood routine, complications were compared among the groups.
RESULTS
The technical success rates for PTCD and ERCP in palliative group were 97.1% and 85.9%. In palliative drainage group, PTCD had higher levels of total bilirubin (TB) reduction (53.0 (30.0,97.0) vs. 36.8 (17.9,65.0), p < 0.001) and direct bilirubin (DB) reduction (42.0 (22.0,78.5) vs. 28.0 (12.0,50.8), p = 0.001) than ERCP. However, PTCD was associated with higher rates of drainage tube displacement (20 cases, 11.8%), while ERCP had a higher incidence of biliary infection (39 cases, 22.8%) and pancreatitis (7 cases, 4.1%). In preoperative drainage group, PTCD achieved a 50% reduction in total bilirubin faster than ERCP (7.1 days vs. 10.5 days). And the time from palliation of jaundice to surgery was 24.2 days in PTCD group and 35.7 days in ERCP group, a statistically significant difference (Student's t test, p = 0.017).
CONCLUSION
Both PTCD and ERCP could improve liver function for MOJ patients. PTCD seems to offer better outcomes in jaundice reduction and liver function improvement in palliative drainage, but requires careful postoperative management. In preoperative biliary drainage, PTCD may be a better preoperative bridge to improve liver function and control infection.
目的
本研究旨在评估经皮经肝胆管引流术（PTCD）和内镜逆行胰胆管造影术（ERCP）在恶性梗阻性黄疸（MOJ）姑息性引流和术前胆道引流中的安全性和有效性。
方法
共纳入 520 例 MOJ 患者，分别行 PTCD 或 ERCP 治疗，并分为姑息性引流组和术前胆道引流组。比较两组患者的一般资料、肝功能、血常规及并发症等情况。
结果
PTCD 和 ERCP 在姑息性引流组的技术成功率分别为 97.1%和 85.9%。在姑息性引流组中，PTCD 可更显著降低总胆红素（TB）（53.0（30.0，97.0）比 36.8（17.9，65.0），p<0.001）和直接胆红素（DB）（42.0（22.0，78.5）比 28.0（12.0，50.8），p=0.001）。然而，PTCD 引流管移位的发生率较高（20 例，11.8%），而 ERCP 则更易发生胆道感染（39 例，22.8%）和胰腺炎（7 例，4.1%）。在术前胆道引流组中，PTCD 较 ERCP 更快地使总胆红素降低 50%（7.1 天比 10.5 天）。PTCD 组从黄疸缓解到手术的时间为 24.2 天，ERCP 组为 35.7 天，差异有统计学意义（Student's t 检验，p=0.017）。
结论
PTCD 和 ERCP 均可改善 MOJ 患者的肝功能。PTCD 似乎在姑息性引流中能更好地降低黄疸和改善肝功能，但需要术后谨慎管理。在术前胆道引流中，PTCD 可能是一种更好的术前桥梁，可改善肝功能并控制感染。
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