The Comparison Between By ERCP And By PTCD Metal Stent In Treatment Of Malignant Obstructive Jaundic

Objective:By the compararion between by ERCP by PTCD metal stenting in treatment of malignant obstructive jaundice,compare success rate of surgery in patients with malignant obstructive jaundice, jaundice improve the situation, more postoperative complications, length of stay, hospital costs, operation costs and other issues, to explore the ERCP (endoscopic retrograde cholangiopancreatography) pathway and by PTCD (percutaneous biliary drainage tube) pathway biliary metallic stent placement for treatment of malignant obstructive jaundice pros and cons, to better guide clinical treatment.Methods:From January2008to December2012were treated in parallel by ERCP or by PTCD biliary metal stenting in patients with malignant obstructive jaundice of160cases (157people, three people after a failed ERCP diverted PTCD treatment) divided in accordance with the choice of treatment group into PTCD group and ERCP group (ERCP group of65patients, PTCD group of95cases). Comparison of these two groups of patients if there are significant differences in terms of success rate of surgery, treatment, complications, length of stay, hospital costs, operation costs, combined with the analysis and discussion of the relevant literature.Results:A total of157cases of malignant yellow barrier clinical data of patients,113cases were male,44female, male to female ratio was2.6:1, aged56years to88years. The success rate:ERCP group and surgical success rate PTCD group were as follows:93.85%,94.74%. No statistically significant difference (Table5, P>0.05) both success rate; low malignant obstruction cases, ERCP group consisting of power PTCD were94.44%(61/65),96.15%(92/95), no significant difference (table3, P>0.05); high malignant obstruction cases, ERCP group of surgical success rate of less than PTCD group (90.91%vs97.10%), statistically significant (table4, P<0.05). Treatment effect:ERCP group and PTCD group jaundice remission rates were88.52%,90.22%, no significant difference (Table8, P>0.05); low malignant obstruction, ERCP group jaundice improvement rate (90.20%) than PTCD group (80.0%), a significant difference (table6, P<0.05); high malignant biliary obstruction, ERCP group jaundice improvement rate (80.0%) lower than PTCD group (94.03%), a significant difference (table7, P<0.05). Serious complications: ERCP group PTCD with serious postoperative complication rate were6.36%,13.04%(Table11, P<0.05); low malignant obstruction, ERCP serious postoperative complication rate is lower than PTCD group (3.92%vs16.00%), there was significant difference (table9, P<0.05); high malignant biliary obstruction, ERCP serious postoperative complication rate in PTCD group (20.00%vs11.94%), there was significant difference (table10, P<0.05). Length of stay:ERCP group of patients with successful surgery hospital stay was13.4±2.8天, PTCD group of patients with successful surgery hospital stay was19.7±4.5days (except the three first choice PTCD ERCP in patients after failure), there was between the two (Table13, P<0.05), ERCP group of hospital stay less than PTCD groups. Hospitalization expenses (excluding three diverted after ERCP failure patients treated PTCD):ERCP group of successful surgery in patients hospitalized cost47947.09±4703.20yuan; hospitalization expenses successful surgery patients PTCD group51348.90±6124.31yuan, a statistically significant difference between the two (table14, P<0.05), ERCP group of patients with successful surgery hospitalization costs less than PTCD group. Surgery costs:ERCP patients surgery cost23415.2±3104.10yuan; PTCD cost of surgery patients was22295.4±2534.04yuan, a statistically significant difference between the two (Table15, P<0.05), ERCP group were higher than the cost of surgery PTCD group.Conclusion:ERCP group and PTCD group have high success rate (93.85%vs 94.74%), and can effectively reduce jaundice. For low malignant obstruction cases, the success rate of surgery ERCP group and no significant difference PTCD group; ERCP group jaundice improvement rate (90.20%) than PTCD group (80.0%); ERCP serious postoperative complication rate is lower than PTCD group (3.92%vs16.0%). For high obstruction cases:ERCP group of surgical success rate of less than PTCD group (90.91%vs97.10%); ERCP group jaundice improvement rate (80.0%) lower than PTCD group (94.03%); ERCP group was the high incidence of serious complications at PTCD group (20.0%vs11.94%). ERCP group, the average length of stay is less than PTCD group (13.4±2.8days vs19.7±4.5days). ERCP group is less than the average cost of hospitalization PTCD group (47947.09±4703.20yuan vs51348.90±6124.31yuan), but slightly higher than the average cost of surgery PTCD group (23415.2±3104.10yuan vs22295.4±2534.04yuan). For low biliary obstruction, ERCP treatment with jaundice improvement rate, severe postoperative complication rate advantage, and therefore low in patients with biliary obstruction conditional line of ERCP treatment, first recommended choice ERCP-related treatment; For high biliary obstruction, PTCD surgical treatment has a high success rate of serious postoperative complication rate is relatively low, jaundice advantage of a relatively high rate of improvement, and therefore high for patients with malignant obstructive jaundice select PTCD related treatment. In addition, for the treatment of patients ERCP can not be completed, PTCD treatment still has its indications.