两种途径治疗胆道恶性梗阻的对比分析(1)
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【摘要】 目的 分析比较经胃十二指肠镜放置内支架引流(ERBD)和经皮肝穿刺胆管放置内支架引流(PTBS)治疗恶性梗阻性黄疸的效果。 方法 收集经ERBD和PTBS治疗的晚期恶性梗阻性黄疸患者68例，其中49例行ERBD治疗(ERBD组)，19例行PTBS治疗(PTBS组)。观察两组一次性手术成功率、并发症发生率、术后2周血清总胆红素水平及术后住院时间。结果 两组手术一次性成功率比较差异无统计学意义(P>0.05)，ERBD组的并发症发生率显著低于PTBS组(P<0.05)。ERBD组45例和PTBS组17例一次性手术成功的患者中，术后2周血清总胆红素水平均较术前显著降低(P<0.01),组间比较差异无统计学意义(P>0.05)。ERBD组术后住院时间显著短于PTBS组(P<0.01)。结论 ERBD和PTBS均为治疗晚期恶性梗阻性黄疸的有效方法，但ERBD比PTBS并发症少，术后住院时间短，PTBS可考虑在ERBD失败后和技术条件限制情况下使用。
【关键词】 恶性梗阻性黄疸；胃十二指肠镜放置内支架引流(ERBD)；经皮肝穿刺胆管放置内支架引流(PTBS)
文章编号：1003-1383(2011)06-0697-03 中图分类号：R 735.8 文献标识码：A
doi:10.3969/j.issn.1003-1383.2011.06.04
Comparative analysis of two approaches in the treatment of m alignant biliary obstruction
LIU Yongpan
(First People's Hospital of Yuhang District,Hangzhou,Zhejiang 311100)
【Abstract】 Objective To evaluate the clinical effects of ERBD (endoscopic retrograde biliary drainage ) and PTBS (percutaneous transhepatic biliary stenting ) in the treatment of m alignant biliary obstruction.
Methods 68 cases of advanced m alignant biliary obstruction are chosen,among whom 49 patients were treated by ERBD(ERBD team) and 19 by PTBS(PTBS team).Once operation success rates,complication incidence rates,serum total bilirubin levels within 14 days after operation and the postoperative hospital stays were observed and compared between the two teams.
Results Difference of once operation success rates between the two teams had no statistical significance(P>0.05),but complication incidence rate of the ERBD team was obviously lower than that of the PTBS team(P<0.05). 45 cases of the ERBD team and 17 cases of PTBS team got once operation success, and their serum total bilirubin level within the 14 days after operation were both statistically lower than that before operation(P<0.01),but there was no statistical difference between those of the teams(P>0.05). The postoperative hospital stay of the ERBD team was statistically shorter than that of the PTBS team(P<0.01).
Conclusion ERBD and PTBS are both effective approaches to treat m alignant biliary obstruction. However, PTBS is an alternative procedure to treat m alignant biliary obstruction with higher complication rate and should be recommended for the patients whose endoscopic route failed ......
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