超声内镜引导下胆汁引流治疗ERCP治疗失败的恶性梗阻性黄疸患者疗效初步研究

doi:10.3969/j.issn.1672-5069.2020.05.033

摘要/Abstract

摘要： 目的探讨采用超声内镜引导下胆汁引流术(EUS-BD)和经皮肝胆管引流术(PTBD)再治疗经内镜逆行胰胆管造影术(ERCP)治疗失败的恶性梗阻性黄疸患者的有效性及安全性。方法 2013年1月～2018年12月我院收治的经ERCP治疗失败的恶性梗阻性黄疸患者75例,术前经B超、CT或MRCP等影像学检查证实存在恶性胆管梗阻,其中胰腺癌15例、壶腹部癌12例、胆管癌27例、胆囊癌9例、胃肠道恶性肿瘤侵犯11例和非霍奇金淋巴瘤1例。其中40例接受EUS-BD治疗,35例接受PTBD治疗。结果在40例EUS-BD治疗患者中,采用超声内镜引导下对接技术完成治疗16例(40.0%),在超声内镜引导下顺行技术完成治疗24例(60.0%),其中37例(92.5%)操作成功,在35例PTBD治疗患者中,28例(80.0%)操作成功,EUS-BD治疗患者操作时间为治疗后,EUS-BD治疗患者血清总胆红素水平为(138.7±50.2)μmol/L,显著低于PTBD治疗患者的(162.4±60.2)μmol/L,而血清白蛋白水平为(34.8±3.7)g/L,显著高于PTBD治疗患者的(32.1±4.6)g/L,P<0.05];EUS-BD治疗患者术后并发症发生率为7.5%(3/40),其中胆道出血2例(5.0%),急性胆管炎1例(2.5%),PTBD治疗患者术后并发症发生率为22.9%(8/35,P<0.05),其中胆道出血3例(8.6%),肝包膜下出血1例(2.9%),胆汁性腹膜炎1例(2.9%),胆漏1例(2.9%),胆道感染2例(5.7%)。结论在ERCP治疗失败的恶性胆道梗阻患者,可选择EUS-BD或PTBD进行补救治疗,或许可消退黄疸,暂时减轻病情。

关键词: 恶性梗阻性黄疸, 内镜逆行胰胆管造影术, 超声内镜引导下胆汁引流术, 经皮肝胆管引流术, 治疗 , ,

Abstract: Objective The aim of this study was to compare the efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) in the treatment of patients with malignant obstructive jaundice after failure of endoscopic retrograde cholangiopancreatography (ERCP). Methods 75 patients with malignant obstructive jaundice (pancreatic carcinoma in 15, vater ampulla carcinoma in 12, bile duct carcinaoma in 27, gall bladder carcinoma in 9, gastrointestinal cancer in 11, and non-Hodgkin lymphoma in 1) proven by B-ultrasound, CT or MRCP were recruited in our hospital between January 2013 and December 2018. All the patients had failed ERCP, and 40 were retreated by EUS-BD, and 35 received PTBD. Results The operation success rate in 40 EUS-BD-treated patients was 92.5%, not significantly different as compared to 80.0% in 35 PTBD-treated patients , and the operational times were also not significantly different between the two groups [(50.8±28.4)min vs. (54.7±25.2)min, P>0.05); after treatment, serum bilirubin level was(138.7±50.2)μmol/L, significantly lower than (162.4±60.2)μmol/L, while serum albumin level in EUS-BD-treated group was (34.8±3.7)g/L, much higher than [(32.1±4.6)g/L,P<0.05] in TPBD-treated group; the incidence of post-operational complications in the former was 7.5%(3/40), including biliary hemorrhage in 2, acute cholangitis in 1, and it was 22.9%(8/35, P<0.05) in the latter, including biliary hemorrhage in 3, subhepatic capsular hemorrhage in 1, bile peritonitis in 1, bile leakage in 1 and biliary tract infection in 2. Conclusion The alternative application of EUS-BD or PTBD in failed ERCP patients is feasible, and might temporarily improve jaundice subside.

Key words: Malignant obstructive jaundice, Endoscopic retrograde cholangiopancreatography, Endoscopic ultrasound-guided biliary drainage, Percutaneous transhepatic biliary drainage, Therapy

庄东海, 张振, 吴善彬. 超声内镜引导下胆汁引流治疗ERCP治疗失败的恶性梗阻性黄疸患者疗效初步研究[J]. 实用肝脏病杂志, 2020, 23(5): 735-738.

Zhuang Donghai,Zhang Zhen,Wu Shanbin.. Therapeutic effect of endoscopic ultrasound-guided bile drainage for the treatment of patients with malignant obstructive jaundice after failed ERCP[J]. Journal of Practical Hepatology, 2020, 23(5): 735-738.

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