摘要
目的 对比超声内镜引导下胆道引流术(EUS-BD)与经皮肝穿刺胆道引流术(PTBD)两种方法对于内镜逆行胰胆管造影术(ERCP)失败的梗阻性黄疸患者的疗效。方法 回顾性分析2015年9月至2021年3月在常州市第一人民医院行ERCP失败后行EUS-BD的29例梗阻性黄疸患者(EUS-BD组)临床资料,随机选取相同时间段、相同适应证的接受PTBD的30例梗阻性黄疸患者纳入PTBD组。比较两种方法的技术成功率、临床有效率、并发症、术后1个月内再干预率和术后住院时间。结果 EUS-BD组中,25例患者获得技术成功(86.2%),其中25例临床有效(100%);PTBD组中,28例患者获得技术成功(93.3%)(P>0.05),其中25例临床有效(89.3%)(P>0.05);2组技术成功率和临床有效率比较,差异无统计学意义(P>0.05)。EUS-BD组并发症发生率16.0%,PTBD组为28.6%,差异无统计学意义(P>0.05)。干预率EUS-BD组显著低于PTBD组(4.2%vs25.0%,P<0.05)。EUS-BD组术后住院时间为(13.6±7.8)d, PTBD组为(12.8±8.4)d,差异无统计学意义(P>0.05)。结论 EUS-BD与PTBD均能有效缓解ERCP失败的梗阻性黄疸,两者相比操作成功率、临床有效率及并发症发生率均相当,但EUS-BD短期再干预率较低,其中腔内胆道引流联合EUS引导顺行胆汁引流术(EUS-AG)能更有效地缓解黄疸,可作为ERCP失败的梗阻性黄疸患者的一线治疗方案。
Objective To compare the effectiveness of endoscopic ultrasound-guided biliary drainage(EUS-BD) and percutaneous transhepatic biliary drainage(PTBD) in patients with obstructive jaundice after failed endoscopic retrograde cholangiopancreatography(ERCP). Methods From September 2015 to March 2021, 59 patients undergoing obstructive jaundice receiving EUS-guided or percutaneous biliary drainage were enrolled in this study, including 29 cases in EUS-BD group and 30 cases in PTBD group. Technical success, clinical success, complications, re-intervention rate and postoperative hospital stay were compared. Results In EUS-BD group, 25 patients achieved technical success(86.2%), of which 25 patients were clinically effective(100%). In PTBD group, 28 patients achieved technical success(93.3%)(P>0.05), of which 25 patients were clinically effective(89.3%)(P>0.05). The technical success and clinical success rates had no significantly different(P>0.05). The incidence of complications in the two groups was 16.0% and 28.6%, respectively(P>0.05). The short-term re-intervention rate in EUS-BD group was significantly lower than that in PTBD group(4.2% vs 25.0%, P<0.05). Postoperative hospital stay was(13.6±7.8) days in EUS-BD group and(12.8±8.4) days in PTBD group(P>0.05). Conclusion EUS-BD and PTBD can both effectively relieve the obstructive jaundice. The technical success, clinical effective rate and complication rate in the two groups were comparable. However, the short-term re-intervention rate in EUS-BD group was lower. Endoscopic hepaticogastrostomy with endoscopic antegrade stenting(EUS-AG) can relieve jaundice more effectively, and can be used as the first-line treatment for patients with obstructive jaundice after ERCP failure.
作者
张银
张悦
陈炳芳
孙克文
王莉
陈建平
汤美
丁炎波
ZHANG Yin;ZHANG Yue;CHEN Bing-fang;SUN Ke-wen;WANG Li;CHEN Jian-ping;TANG Mei;DING Yan-bo(Department of Gastroenterology,the Third Affiliated Hospital of Soochow University/the First People′s Hospital of Changzhou,Changzhou 213003,Jiangsu,China;Department of Hepatopancreatobiliary Surgery,the Third Affiliated Hospital of Soochow University/the First People′s Hospital of Changzhou,Changzhou 213003,Jiangsu,China)
出处
《东南国防医药》
2022年第2期133-137,共5页
Military Medical Journal of Southeast China
基金
常州市卫生健康青苗人才培养工程资助(CZQM2020017)。
关键词
梗阻性黄疸
内镜逆行胰胆管造影术
超声内镜引导下胆道引流术
经皮肝穿刺胆道引流术
obstructive jaundice
endoscopic retrograde cholangiopancreatography
endoscopic ultrasound-guided biliary drainage
percutaneous transhepatic biliary drainage
