| Malignant biliary obstruction is a type of disease caused by malignant tumor invasion or compression of the bile duct.Most of the primary diseases are difficult to diagnose early beacaus of their insidious and aggressive.Most of diseases cannot be directly operated or no surgical opportunity generally.So biliary drainage has become the first step of treatment choice for patients.However,how to choose a more appropriate first step treatment method for patients,is a major clinical problem.Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic choledochal drainage are used drainage methods in clinical practice commonly.Both methods have advantages and disadvantages for biliary obstruction at different sites.Therefore,choosing a better primary biliary drainage method according to the advantages and disadvantages is the focus of this study.Objective:The short-term efficacy of initial endoscopic retrograde cholangiopancreatography(ERCP)and percutaneous transhepatic choledochal drainage(PTCD)for malignant biliary obstruction was compared through retrospective analysis.So as to provide a basis for the selection of primary clinical treatment of malignant biliary obstruction.Methods:A total of 100 patients who received ERCP or PTCD treatment for the first time were retrospectively analyzed for malignant biliary obstruction cases admitted to the Department of Hepatobiliary Surgery and Interventional Medicine of our hospital from January 2017 to August 2021.The patients in different biliary tract drainage methods were divided into ERCP group(59 cases)and PTCD group(41 cases),and objective indicators such as gender,age,disease type,obstruction location,preoperative jaundice days,operation success rate,postoperative liver function improvement,and postoperative complications were collected and compared.Statistical analysis using SPSS 21 analysis software.Results:A total of 100 patients were collected,including 59 cases in ERCP group,34 cases of males,25 cases of women,33 cases of proximal biliary obstruction and 26 cases of distal biliary obstruction,including 24 cases of cholangiocarcinoma,13 cases of ampullary carcinoma,7 cases of pancreatic cancer,9 cases of liver cancer,1 case of gallbladder carcinoma,and 5 cases of other malignant tumors(colon cancer,appendix mucinous carcinoma,breast cancer systemic multiple metastasis,gastric cancer),with an average age of 64.37±13.28 years.There were 41 cases in the PTCD group,25 males,16 females,24 cases of proximal biliary obstruction and 17 cases of distal biliary obstruction,including 19 cases of cholangiocarcinoma,3 cases of ampullary cancer,8 cases of pancreatic carcinoma,4 cases of liver cancer,1 case of gallbladder cancer,and 6 cases of other malignant tumors(colon cancer,appendix mucus carcinoma,breast cancer systemic multiple metastasis,gastric cancer),with an average age of 67.54±14.29 years.There were no significant differences in sex,obstruction site,disease type,preoperative jaundice days,and liver function between the two groups(P>0.05).The postoperative bilirubin,alanine aminotransferase and alkaline phosphatase indexes decreased significantly in both groups of patients with proximal or distal biliary obstruction,and the above indicators were statistically significant compared with preoperative(P<0.05),and the difference in decline between the two groups was not statistically significant(P>0.05).In terms of the success rate of initial catheterization,PTCD is better than ERCP regardless of proximal or distal biliary obstruction,but the difference in proximal obstruction is statistically significant(P<0.05).In the comparison of the overall complication rate between the two groups,PTCD was also significantly lower than ERCP,and the difference was statistically significant(P<0.05).Conclusion:PTCD and ERCP are effective yellowing reduction methods.PTCD has a higher success rate and fewer complications in proximal biliary obstruction. |
PDF Full Text Request