Wang Wei, Zhang Chao, Li Bing, Yuan Ge-Yi-Lang, Zeng Zhi-Wu
Department of Hepatobiliary Surgery, Wuhan No. 1 Hospital, Wuhan 430000, Hubei Province, China.
Department of General Surgery, Shenzhen University General Hospital, Shenzhen 518000, Guangdong Province, China.
World J Gastrointest Surg. 2025 Jan 27;17(1):97596. doi: 10.4240/wjgs.v17.i1.97596.
Malignant obstructive jaundice (MOJ) is characterized by the presence of malignant tumors infiltrating or compressing the bile duct, causing poor bile drainage, generalized yellowing, pain, itching, and malaise. MOJ is burdensome for both the society and the families of affected patients and should be taken seriously.
To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement, complication rates, and long-term patient outcomes.
The clinical data of 59 patients with MOJ who were admitted to our hospital between March 2018 and August 2019 were retrospectively analyzed. According to the treatment method, the patients were divided into an observation group (29 patients) and a control group (30 patients). General data, liver function indices, complications, adverse effects, and 3-year survival rates after different surgical treatments were recorded for the two groups.
There were no significant differences in baseline information (sex, age, tumor type, or tumor diameter) between the two groups ( > 0.05). Alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels were significantly better in both groups after surgery than before surgery ( < 0.05). The overall incidence of biliary bleeding, gastrointestinal bleeding, pancreatitis, and cholangitis was 6.9% in the observation group and 30% in the control group ( < 0.05). No significant differences in the rates of blood transfusion, intensive care unit admission, or death within 3 years were observed between the two groups at the 1-month follow-up ( > 0.05). The 3-year survival rates were 46.06% and 39.71% in the observation and control groups, respectively.
Endoscopic biliary stenting effectively relieves MOJ and significantly improves liver function, with minimal complications. This technique is a promising palliative approach for patients ineligible for radical surgery. However, further research is needed to optimize current treatment strategies and to explore their potential in treating nonmalignant cases of obstructive jaundice.
恶性梗阻性黄疸（MOJ）的特征是存在浸润或压迫胆管的恶性肿瘤，导致胆汁引流不畅、全身发黄、疼痛、瘙痒和不适。MOJ对社会和受影响患者的家庭来说都是沉重负担，应予以重视。
评估内镜逆行胰胆管造影术中支架置入术缓解MOJ的临床效果，以及经皮肝穿刺胆道引流术在改善肝功能、并发症发生率和患者长期预后方面的疗效。
回顾性分析2018年3月至2019年8月我院收治的59例MOJ患者的临床资料。根据治疗方法，将患者分为观察组（29例）和对照组（30例）。记录两组不同手术治疗后的一般资料、肝功能指标、并发症、不良反应及3年生存率。
两组患者的基线信息（性别、年龄、肿瘤类型或肿瘤直径）无显著差异（P>0.05）。两组患者术后丙氨酸氨基转移酶、天冬氨酸氨基转移酶和总胆红素水平均显著优于术前（P<0.05）。观察组胆道出血、胃肠道出血、胰腺炎和胆管炎的总发生率为6.9%，对照组为30%（P<0.05）。1个月随访时，两组患者输血率、入住重症监护病房率或3年内死亡率无显著差异（P>0.05）。观察组和对照组的3年生存率分别为46.06%和39.71%。
内镜下胆道支架置入术能有效缓解MOJ，显著改善肝功能，并发症极少。该技术对于不适合根治性手术的患者是一种有前景的姑息治疗方法。然而，需要进一步研究以优化当前治疗策略，并探索其在治疗非恶性梗阻性黄疸病例中的潜力。
