| BackgroundThe common cause of malignant obstructive jaundice is mainly due to malignant tumors,such as biliary tumors,pancreatic tumors,ampullary tumors,enlarged lymph nodes,liver cancer and its metastasis or infiltration of the common bile duct,common hepatic duct or left and right hepatic ducts,resulting in bile duct stricture The damage caused by cholestasis and liver function is a group of diseases that are difficult to diagnose and treat clinically.Mainly manifested as progressive aggravation of jaundice,systemic infection leads to shock,and then liver failure,coagulopathy,decreased body immunity leading to systemic infection,sepsis,serious life-threatening,high mortality.92% of patients die within six months without timely clinical intervention.The radical resection rate is low,and 80% of patients can achieve palliative biliary drainage to relieve jaundice and relieve symptoms.Currently,palliative treatments commonly used in clinical practice include ERCP biliary drainage,PTCD and ultrasound.Microscopic drainage of the biliary tract.Over the years,the advantages and disadvantages of various palliative drainage techniques have become the focus of research..ObjectiveRetrospective analysis of the clinical data of different surgical methods of ERCP,PTCD and endoscopic biliary drainage in our hospital,objectively evaluated the advantages,disadvantages and clinical features of palliative drainage,providing more reference for clinical.MethodDuring the period from June 2017 to July 2018,56 patients with malignant biliary obstruction who were judged to be unable to undergo surgery after consultation in various departments were enrolled.The ERCP-guided biliary drainage,PTCD and endoscopic biliary drainage were used.The treatment methods were divided into ERCP group,PTCD group and EUS group.The changes of liver function indexes,postoperative complications,hospitalization time and survival time were analyzed before and after operation.Result(1)For the treatment of malignant obstructive jaundice,these three palliative biliary drainage are effective,there is no significant difference in alleviating jaundice symptoms,improving liver function indicators,and prolonging survival time.Therefore,these three palliative biliary drainage methods The treatment plan can be used as an effective measure for the treatment of patients with malignant obstructive jaundice.(2)The complications of the endoscopic ultrasonography group were less than those of the ERCP group and the PTCD group,and the three groups were statistically different(p<0.05).(3)Compared with the three hospitalization days,the average hospital stay in the endoscopic group was shorter than that in the ERCP group and the PTCD group,and the difference between the three groups was significant(p<0.05).(4)Both ERCP and endoscopic ultrasound are in the natural cavity.Bile drainage is more in line with the physiological anatomical structure.Compared with PTCD,the acid-base and electrolyte imbalance caused by long-term biliary outflow is reduced,and the catheter slip and infection are avoided.(5)Ultrasound endoscopy has the advantages of endoscope and ultrasound.Compared with PTCD,the puncture path is shorter.Without external drainage tube and drainage bag,it can avoid large blood vessels under real-time ultrasound imaging,greatly reducing Complications occur;compared to ERCP,it does not rely on the duodenal papilla,can be puncture drainage and stent placement in the stomach and duodenum.ConclusionFor patients with malignant obstructive jaundice,ERCP,PTCD,and endoscopic techniques are effective for palliative biliary drainage.The three procedures have their own advantages and disadvantages.Compared with ultrasound endoscopy,the advantages are greater,but Because the sample size of this study is too small and is a retrospective study,it is still necessary to have a big data prospective and central controlled study to fully understand whether endoscopic biliary drainage can be a first-line treatment. |
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