Comparison Of Two Different Interventional Methods In The Treatment Of Malignant Obstructive Jaundice

Background Patients with malignant obstructive jaundice have no obvious symptoms in the early stage,and the clinical manifestations are not obvious.The results of laboratory examination and imaging examination are also lack of specificity for the early diagnosis of the disease.Therefore,after the diagnosis of a considerable number of patients,the tumor has usually developed into advanced stage,and the best time for surgical resection of the tumor has been lost.Conservative drug treatment is difficult to relieve the clinical symptoms of patients in a short period of time.Once the symptoms of jaundice continue to worsen,it will affect the normal metabolism of various organs and systems of the whole body,and sharply reduce the survival time and quality of life of patients.At present,there is no unified clinical treatment for patients with this kind of disease.Early patients can be cured by surgery,but the early clinical manifestations are not obvious,and the diagnosis rate is low.Late stage may have obvious symptoms and signs,but the timing of operation is not suitable.Palliative symptomatic treatment has become the mainstream treatment.Objective To retrospectively analyze 115 patients with malignant obstructive jaundice in our hospital from January 2018 to April 2020.By comparing the treatment effect of two different interventional methods on patients with high and low malignant obstructive jaundice from the aspects of the speed of reducing jaundice,the proportion of patients,the changes of liver function after operation,and the hospitalization expenses.We expect to explore a more safe,effective,economic and better prognosis advice to provide reference for clinical diagnosis and treatment towards such kind of patients.Methods The patients were divided into ERCP group and PTCD group.The preoperative and postoperative AST(aspartate aminotransferase),ALT(alanine aminotransferase),serum bilirubin,Urine Bilirubin,ALP(alkaline phosphatase)and γ-GT(γ-GT)were collected The change rate of bilirubin in ERCP group and PTCD group,the change ratio of total bilirubin in the same period of time,the time required for the bilirubin index to return to normal in ERCP and PTCD corresponding high and low obstruction patients,postoperative bleeding,bile leakage,biliary tract infection,water electrolyte dysfunction,catheter and stent The length of hospital stay and the cost of hospitalization after operation.Results After ERCP and PTCD,bilirubin,alanine aminotransferase,aspartate aminotransferase,r-GT,alkaline phosphatase and other liver function indexes of patients with malignant obstructive jaundice were significantly decreased,especially in the first day after operation,such indexes decreased most significantly,the results were statistically significant;by about the seventh day after operation,all indexes basically returned to normal range.The liver function indexes of the two methods were basically the same at the same time,and there was no significant statistical difference in the results;however,in high obstruction,PTCD patients were obviously able to operate more smoothly,and the probability of postoperative pancreatitis and other complications was smaller than ERCP,and the results were statistically different;in low obstruction,ERCP could reduce the damage to high normal tissue,and the patients with postoperative bile leakage,infection,and other complications Dislocation is also relatively rare.The total complication rate of ERCP was lower than that of PTCD.The length of hospital stay after ERCP was shorter than that after PTCD,but the cost was higher.Conclusion ERCP and PTCD are effective interventional methods for palliative jaundice reduction in patients with advanced malignant obstructive jaundice.However,the size and location of the tumor have an important influence on the choice of interventional therapy.For patients with high malignant obstruction,PTCD is safer,more effective and faster to relieve jaundice symptoms,and it is easier to replace drainage and reoperation to relieve secondary obstruction.The cost and treatment effect are more easily accepted by patients.For patients with low malignant obstructive jaundice,ERCP plays an important role in reducing jaundice,which is closer to the physiological channel of transport,and in delaying biliary and pancreatic duct stenosis.In the later stage,stent implantation and internal radiotherapy can be performed through the pipeline system.It is a good choice for patients with low malignant biliary obstruction.Therefore,the choice of treatment for patients with malignant obstructive jaundice needs to be comprehensively considered from the nature of the patient’s own tumor and the patient’s expectations.After then the patients can get the maximum benefit from the treatment.