Therapeutic Effect Of Palliative Jaundice Reduction By ERCP And PTCD In Patients With Advanced Malignant Obstructive Jaundice

Background : Hilar Cholangiocarcinoma(h CCA)is an aggressive malignancy of the extrahepatic bile ducts.Radical resection(R0 resection)was considered to be the best approach to achieve long-term survival rate for patients.However,most patients with type Bismuth?and IV,have lost the opportunity for radical surgery at the beginning of diagnosis,owing to extensive hilar or secondary bile duct invasion,insufficient of remnant liver volume after surgery,lymph node metastasis,and vascular invasion.Furthermore,for patients with resectable h CCA,due to serious complications,high recurrence rates and poor outcomes,the5-year survival rate was low.Especial for patients with obstructive jaundice,the average survival time was less than 3 months if not treated in time.Nowadays,percutaneous transhepatic cholangial drainage(PTCD)and endoscopic retrograde cholangio pancreatography(ERCP)were performed as an effective to treat obstructive jaundice.As a palliative method,it has advantages both in anesthesia equipment requirement and less traumatic compared to choledochojejunostomy.However,the actual efficacy and perioperative complication rate of these two approaches were not known.Aim: To investigate the effects and complication rate of PTCD and ERCP in patients with obstructive jaundice at the stage Bismuth ? and ?,provide evidence for clinical decision making.Methods: 68 h CCA cases of Bismuth? and ? from September 2015 to December2019 in The Affiliated Hospital of Hebei University were retrospectively analyzed.All of patients showed obstructive jaundice and cannot be treated with radical surgery.33 cases were treated with biliary stent placement via ERCP and 35 cases were drainage by PTCD.Preoperative and postoperative clinical data were collected and compared.Results:Patients with jaundice,abdominal pain,fever,and skin pruritus were improved compared with preoperative.The value of ALT,AST,GGT,TBA and TBI were significantly decreased after operation both in group ERCP and PTCD(P<0.05),but there was nosignificant difference of descent degree between the two groups(P>0.05).There was no statistical significance of early operative complication between group ERCP and PTCD,however,the PTCD group showed higher rate of late postoperative complications compared with ERCP group(P<0.05).What is more,there was no statistically significant difference between ERCP group and PTCD group in the average hospitalization days(P>0.05),but the costs of hospitalization in ERCP group was significantly higher than that in PTCD group(P<0.05).Conclusion:1.According to the results,both PTCD and ERCP can relieve the biliary obstruction so that improve liver function,but there is no significant difference in the therapeutic effects between these two methods.2.There was no significant difference in the early operative complication rate between PTCD and ERCP,but PTCD group showed higher rate of late postoperative complications.3.The cost of ERCP was significantly higher than PTCD,but there was no significant difference in the length of stay in hospital between the two groups.In conclusion,both ERCP and PTCD are suitable for Bismuth ? and Bismuth ?patients with biliary obstruction.But the rate of late postoperative complications was lower in ERCP and patients did not need a tube retention,so ERCP could be considered as the first choice for patients.And PTCD can be considered as an important supplement to ERCP after ERCP failed.