摘要
目的:探究经内镜逆行胰胆管造影（ERCP）胆道支架植入与经皮肝穿刺胆道引流术（PTCD）治疗恶性梗阻性黄疸（MOJ）疗效及对免疫功能的影响。方法:回顾性分析2021年1月至2022年12月117例MOJ患者资料，根据不同术式分为两组，ERCP组（行ERCP胆道支架植入治疗，n=58）和PTCD组（行PTCD治疗，n=59）。采用SPSS 19.0软件分析数据，手术指标、肝功能、免疫功能等计量资料采用独立样本t检验；梗阻类型、临床疗效、并发症等计数资料以[例（%）]表示，采用χ2检验或秩和检验。P<0.05为差异有统计学意义。结果:术后7 d ERCP组患者低位梗阻有效率（92.7%）高于PTCD组（69.2%），高位梗阻有效率（70.0%）低于PTCD组（90.9%）（P均<0.05）；两组患者直接胆红素（DBIL）、腺苷脱氨酶（ADA）、碱性磷酸酶（ALP）、谷氨酰基转移酶（GGT）水平均较术前降低，PTCD组低于ERCP组（P均<0.05）；T淋巴细胞亚群（CD3+、CD4+、CD4+/CD8+）水平均较术前降低，但ERCP组高于PTCD组（P均<0.05）。结论:ERCP胆道支架植入与PTCD均可有效治疗MOJ，可改善患者肝功能和免疫功能，但PTCD更适用于高位MOJ，ERCP胆道支架植入更适用于低位MOJ。
Abstract
Objective:To explore the therapeutic effect of endoscopic retrograde cholangiopancreatography (ERCP) biliary stent implantation and percutaneous hepatic puncture biliary drainage (PTCD) on malignant obstructive jaundice (MOJ) and its influence on immune function.Methods:The data of 117 patients with MOJ from January 2021 to December 2022 were retrospectively analyzed and divided into two groups according to different operation methods: ERCP group (ERCP biliary stent implantation, n=58) and PTCD group (PTCD treatment, n=59). SPSS 19.0 software was used to analyze the data, and independent sample t test was used for measurement data such as surgical indicators, liver function and immune function. The statistical data of obstruction type, clinical efficacy, complications, etc. were shown as [example (%)], and χ2 test or Rank Sum test were used. P<0.05 was considered statistically significant.Results:On the 7th day after operation, the effective rate of low obstruction in ERCP group (92.7%) was higher than that in PTCD group (69.2%), and the effective rate of high obstruction in ERCP group (70.0%) was lower than that in PTCD group (90.9%) (P <0.05). The levels of direct bilirubin (DBIL), adenosine deaminase (ADA), alkaline phosphatase (ALP) and glutamyltransferase (GGT) in 2 groups were lower than before surgery, and those in PTCD group were lower than those in ERCP group (all P <0.05). The levels of T lymphocyte subsets (CD3+, CD4+, CD4+/CD8+) in ERCP group were lower than those in PTCD group (P <0.05).Conclusion:Both ERCP biliary stent implantation and PTCD can effectively treat MOJ and improve liver function and immune function of patients. However, PTCD is more suitable for high MOJ, and ERCP biliary stent implantation is more suitable for low MOJ.
基金项目
四川省自然科学基金项目(2023NSFSC1621)
万方数据