三种胆道引流手术治疗恶性阻塞性黄疸的疗效分析

摘 要] 目的 比较经皮肝穿刺胆管引流术（percutaneous transhepatic cholangial drainage，PTCD）、经皮经肝胆囊穿刺引流术（percutaneous transhepatic gallbladder drainage，PTGBD）、经内镜鼻胆管引流术（endoscopic nasobiliary drainage，ENBD）治疗恶性阻塞性黄疸的临床疗效。方法 回顾性分析2012年10月至2017年10月上海交通大学医学院附属仁济医院收治的85例实施术前胆道引流的恶性阻塞性黄疸患者的临床资料，根据手术方式将患者分为PTCD组（n=48）、PTGBD组（n=19）和ENBD组（n=18）。比较三组的手术前后血清总胆红素水平、手术成功率、手术时间、术后并发症、术后减黄效果。结果 三组患者术前、术后第3天和第7天总胆红素水平、手术成功率及术后并发症发生率无统计学差异（P > 0.05）。PTGBD组平均手术时间（14.11±0.6439）min]明显低于PTCD组的（19.07±0.8799）min、ENBD组的（29.67±1.921）min，三组比较有统计学差异（F=916.858，P < 0.001），两两组间比较均有统计学差异（均P < 0.001）。结论 PTCD、PTGBD和ENBD均能达到术前减黄的效果，PTGBD更为便捷、安全。

Analysis of three kinds of biliary drainage methods for treatment of malignant obstructivejaundice

Abstractobjective To evaluate the benefits of percutaneous transhepatic cholangial drainage (PTCD),percutaneous transhepatic gallbladder drainage (PTGBD) and endoscopic nasobiliary drainage (ENBD) fortreatment of malignant obstructive jaundice. Methods Clinical data of 85 cases with malignant obstructivejaundice collected from Renji Hospital between Oct. 2012 and Oct. 2017 was retrospectively analyzed. Accordingto the operative methods, patients were divided into PTCD group (n=48), PTGBD group (n=19) and ENBDgroup (n=18). Preoperative serum total bilirubin level, success rate of operation, operation duration, postoperativecomplications, postoperative effect were compared among three groups. Results There was no significantdifference in preoperative serum total bilirubin level (F=0.332, P=0.718), postoperative serum total bilirubin in3 days (F=0.688, P=0.505) and 7 days (F=1.502, P=0.229) among the three groups. There was no significantdifference in surgical success rate and postoperative complications (all P>0.05) among the three groups. Theoperation duration of PTGBD group (14.11±0.6439) min] was obviously less than PTCD group (19.07±0.8799)min] and ENBD group (29.67±1.921) min]. There was significant difference in operation duration among thethree groups (F=916.858, P<0.001) and pairwise contrast (P<0.001). Conclusion PTCD, PTGBD and ENBD allcan achieve the effect of reducing jaundice before operation, and PTGBD is more convenient and safer.