| Background:Malignant obstruction caused by hilar cholangiocarcinoma is a common clinical symptom in hepatobiliary and pancreatic surgery.Cancer cells invade the bile duct,resulting in poor bile drainage,and reflux of intrahepatic cholestasis leads to dilation of the terminal capillary bile duct,with bile components flowing back into the blood.At the same time,bile produced by normal hepatocytes continues to be secreted into the sinusoids of the liver,which further aggravates jaundice in patients.Obstructive jaundice leading to hepatocellular necrosis and evolving liver failure has also become one of the leading causes of death in patients with hilar cholangiocarcinoma.Currently,radical resection of cancer is the preferred treatment for hilar cholangiocarcinoma.The basic principle of surgery is to resect the diseased bile duct and establish a new drainage pathway,but the radical resection rate is only 10%-20%because the anatomical location of the tumor is usually located in the hilum of the liver,and its biological characteristics are easy to invade the liver and peripheral vascular lymphatic vessels[1].For patients who cannot undergo radical operation after laparotomy exploration,U-tube placement or palliative simple bilioenterostomy are often performed to achieve the purpose of smooth bile drainage.For nearly 90%of patients who cannot undergo radical surgical resection,the prognostic outcome is often death due to various complications such as biliary tract infection caused by obstructive jaundice,so restoring the smooth drainage of bile is the main goal of treatment for such patients.At present,with the progress of endoscopy and interventional technology,non-surgical palliative treatment for hilar cholangiocarcinoma which cannot be radically resected has been adopted by more and more medical institutions.Although the primary lesion has not been resected by non-surgical methods,unblocked biliary drainage can improve the quality of life of advanced patients and prolong the survival time of patients relatively.Compared with palliative surgical treatment,non-surgical treatment has the advantages of shorter hospital stay,faster postoperative recovery,significant yellow reduction effect,and fewer postoperative complications.At present,the commonly used palliative yellow reduction methods in clinic include percutaneous transhepatic cholangiodrainage（PTCD）and endoscopic biliary stenting（EBS）.In clinical practice,both PTCD and EBS have good yellow reduction effect,but there are still controversies about their advantages and disadvantages in the practical application of palliative yellow reduction for advanced hilar cholangiocarcinoma.In this study,we retrospectively analyzed the clinical and follow-up data of patients with hilar cholangiocarcinoma treated with PTCD or EBS in our hospital,and compared the differences between the two treatment schemes in the Yellow reduction effect,length of stay,hospitalization costs and the occurrence of postoperative complications,in order to provide guidance and help for the treatment of the same type of patients in the future.Objective:To retrospectively analyze the efficacy and prognosis of PTCD and EBS in the palliative treatment of patients with advanced hilar cholangiocarcinoma,and to compare the differences between the two treatment schemes in the Yellow reduction effect,length of stay,hospitalization cost,incidence of postoperative complications and postoperative survival time,in order to provide help for the selection of palliative treatment methods for patients with advanced hilar cholangiocarcinoma in the future.Methods:The clinical and follow-up data of HCCA patients admitted to our hospital from January 1,2010 to December 31,2017 and treated with PTCD or EBS were retrospectively analyzed.The incidence of perioperative complications,perioperative mortality and long-term survival of patients in the two groups were collected and compared to evaluate the advantages and disadvantages of the two palliative treatment schemes.The collected data were analyzed by SPSS20.0 software.The t-test was used to compare the sample mean of two groups of patients who met the normal distribution results after the normality test,and the rank sum test was used for those who did not meet the normal distribution results after the test.Rates were compared using chi-square test.P<0.05 means the difference is statistically significant.Result:1.There was no significant difference in the basic data between the two groups.The total bilirubin and direct bilirubin in the two groups after palliative yellow reduction treatment were significantly lower than before,and the difference before and after yellow reduction was statistically significant.There was no significant difference in the effect of yellow reduction between the two groups.2.The number of complications in the two groups accounted for 19.3%and 17.6%of the total number of patients,respectively.There was no significant difference between the two groups.However,the incidence of pancreatitis after EBS yellow reduction was more common than that after PTCD yellow reduction,there was a statistical difference between them（P<0.05）.There was no significant difference in complications of biliary tract infection,bleeding,bile fistula,catheter displacement or obstruction between the EBS group and the PTCD group.3.There was no significant difference in the early recovery index between the two groups.The time of getting out of bed in EBS group was earlier than that in PTCD group（P<0.05）.The pain score of EBS group was significantly lower than that of PTCD group（P<0.05）.4.The hospitalization expenses of the patients in the EBS group and the PTCD group were（28656.99±13973.10）yuan and（23584.15±14306.97）yuan,respectively.There was a statistical difference between the two groups（P=0.001,P<0.05）.It can be seen that the hospitalization expenses in the PTCD group were lower than those in the EBS group.The total length of stay was（14.60±8.29）days in EBS group and（14.24±10.39）days in PTCD group,P=0.107,P>0.05,there was no significant difference between the two groups.5.Comparison of survival timeThe mean survival time of EBS group was 10.11 months,and the median survival time was 9.45 months.The mean survival time of PTCD group was 7.07 months and the median survival time was 5.50 months.The difference of survival time was statistically significant（P=0.002,P<0.05）.Conclusion:For HCCA patients who can not be operated on,choosing an appropriate palliative and yellow reduction therapy can improve the quality of life and prolong the survival time of patients.EBS is the first choice for HCCA patients of type I and type II,because compared with PTCD,EBS has the advantages of small trauma,quick postoperative recovery and little impact on postoperative quality of life.Meanwhile,its bile drainage strategy conforms to the physiological structure and EBS is more consistent with the concept of eras in the field of surgery.EBS and PTCD can be used as palliative measures to reduce jaundice in patients with HCCA of typeⅢandⅣ.However,the selection of the scheme should be based on the specific location of obstruction,the extent of bile duct expansion,the volume of liver that can achieve effective drainage,the experience of the operator and the level of operation. |
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