PTCD在老年恶性梗阻性黄疸ERCP操作失败患者中的疗效观察

[摘 要] 目的 探讨老年恶性梗阻性黄疸（MOJ）患者ERCP操作失败后行PTCD补救治疗的临床疗效。方法 选取53例ERCP操作失败后行PTCD治疗的老年MOJ患者作为研究组，并选取同期46例首选PTCD治疗的老年MOJ患者作为对照组，回顾性分析两组治疗前后临床症状和肝功能变化情况，手术成功率，术后并发症发生率及病死率等。结果 研究组ERCP操作失败的主要原因为肿瘤致胆管严重狭窄，导丝无法通过，占67.9%；失败后行PTCD补救治疗，手术成功率为94.3%，与对照组比较无统计学差异（ χ 2 =0.135，P=0.714）；并发症发生率为30.0%，虽略高于对照组（24.4%），但差异并无统计学意义（ χ 2 =0.368，P=0.544）。由于肿瘤侵犯较重，研究组胆道支架置入成功率明显低于对照组（35.8% vs 69.6%， χ 2 =11.208，P=0.001），但术后2周，研究组临床症状及肝功能各项指标均较术前明显改善（P＜0.01）。两组减黄效果相当，均无死亡病例。结论 老年MOJ患者 ERCP操作失败后行PTCD补救治疗，其手术成功率、并发症发生率及病死率均与首选PTCD治疗无差异，临床疗效显著，值得临床参考。

Effect of PTCd in elderly patients with ERCP failure in malignant obstructive jaundice

Abstract objective To explore the clinical effect of PTCD remedial therapy after ERCP failure in elderly patients with malignant obstructive jaundice (MOJ). Methods A total of 53 elderly patients with MOJ who initiated PTCD treatment after ERCP failure were selected (research group), and 46 elderly patients with MOJ who preferred PTCD treatment in the same period were selected (control group). Clinical symptoms and liver function changes, surgical success rate, incidence of postoperative complications and mortality rate between two groups were retrospectively analyzed. Results In research group, the main reason for ERCP failure was tumor caused severe stenosis of the bile duct (accounted for 67.9%), which could not be passed by the guide wire. PTCD was performed after ERCP failure, the operation success rate was 94.3%, with no statistical difference compared with control group ( χ 2 =0.135, P=0.714). The complication rate in research group was 30.0%, slightly higher than that in control group (24.4%) ( χ 2 =0.368, P=0.544). Due to tumor invasion, the success rate of biliary stent implantation in research group was significantly lower than that in control group (35.8% vs 69.6%, χ 2 =11.208, P=0.001). After two weeks, clinical symptoms and liver function indicators in research group were significantly better than those before operation (P<0.01). Two groups had the same effects of reducing jaundice. No deaths was found. Conclusion After ERCP failure in elderly patients with MOJ, PTCD remedial treatment is put in effect, and the success rate, complication rate and mortality are not different from the preferred PTCD treatment. This operation is worthy of clinical reference.