ERCP术治疗恶性梗阻性黄疸的临床效果及对肝功能指标的影响

临床与实践 Linchuangyushijian

《中外医学研究》第19卷 第3期（总第479期）2021年1月- 40 -

*基金项目：白银市科技计划项目（2019-1-23Y）①白银市第二人民医院　甘肃　白银　730900

ERCP术治疗恶性梗阻性黄疸的临床效果及对肝功能

指标的影响

*

王彩明①

【摘要】　目的：探讨经内镜逆行胰胆管造影（ERCP）术治疗恶性梗阻性黄疸的临床效果及对肝功能指标的影响。方法：回顾性选择2018年9月-2020年2月于本院接受治疗的44例恶性梗阻性黄疸患者作为研究对象，根据治疗方法分为常规组和微创组，每组22例。采用经皮肝穿刺胆道引流（PTCD）的患者列入常规组，采用ERCP 术的患者列入微创组，对两组治疗前后肝功能指标、手术情况和临床疗效进行比较。结果：治疗前，微创组谷草转氨酶、丙谷转氨酶、总胆红素、直接胆红素水平与常规组比较差异无统计学意义（P >0.05）；治疗后，微创组谷草转氨酶、丙谷转氨酶、总胆红素、直接胆红素均低于常规组（P <0.05），微创组术中出血量和手术时间与常规组比较差异无统计学意义（P >0.05），微创组术后下床活动时间、住院时间均优于常规组（P <0.05）；微创组的总有效率（95.45%）高于常规组（68.18%），差异有统计学意义（P <0.05）。结论：ERCP 术治疗恶性梗阻性黄疸的效果显著，能改善患者肝功能，缩短术后下床活动时间和住院时间，提高总有效率，值得临床推广。

【关键词】　经内镜逆行胰胆管造影术　恶性梗阻性黄疸　经皮肝穿刺胆道引流　肝功能指标 doi：10.14033/ki.cfmr.2021.03.016

文献标识码　B

文章编号　1674-6805（2021）03-0040-03

Clinical Effect of ERCP in the Treatment of Malignant Obstructive Jaundice and Its Influence on Liver Function Indexes/WANG Caiming. //Chinese and Foreign Medical Research, 2021, 19(3): 40-42

[Abstract]　Objective: To investigate the clinical effect of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of malignant obstructive jaundice and its influence on liver function indexes. Method: A total of 44 patients with malignant obstructive jaundice who were treated in our hospital from September 2018 to February 2020 were retrospectively selected and divided into the conventional group and the minimally invasive group according to the treatment, with 22 cases in each group. Patients underwent percutaneous transhepatic choledochus drainage (PTCD) were included in the conventional group and those underwent ERCP were included in the minimally invasive group. The liver function indexes, operation conditions and clinical efficacy of the two groups before and after treatment were compared. Result: Before treatment, there was no significant difference in aspartate transaminase, alanine transaminase, total bilirubin and direct bilirubin between the minimally invasive group and the conventional group (P >0.05). After treatment, the aspartate transaminase, alanine transaminase, total bilirubin and direct bilirubin in the minimally invasive group were lower than those in the conventional group (P <0.05). There were no significant differences in intraoperative blood loss and operation time between the minimally invasive group and the conventional group (P >0.05). The time of getting out of bed after surgery and hospitalization time of the minimally invasive group were better than those of the conventional group (P <0.05), and the total effective rate of the minimally invasive group (95.45%) was higher than that of the conventional group (68.18%), the differences were statistically significant (P <0.05). Conclusion: ERCP is effective in the treatment of malignant obstructive jaundice. It can improve the liver function of patients, shorten the time of getting out of bed and hospitalization time, and improve the total effective rate. It is worthy of clinical promotion.

[Key words]　Endoscopic retrograde cholangiopancreatography　Malignant obstructive jaundice　Percutaneous transhepatic choledochus drainage　Liver function

First-author ’s address: The Second People ’s Hospital of Baiyin City, Baiyin 730900, China

恶性梗阻性黄疸是肿瘤压迫肝内或肝外胆道，致胆道狭窄、胆汁排泄受阻、血清胆红素水平增高而造成，恶性梗阻性黄疸临床症状表现为皮肤、巩膜等组织黄染、肝功能下降等。恶性梗阻性黄疸具有较高的病发率，若不早发现早治疗，放任病情恶化，晚期将无法进行外科根治性切除手术，严重威胁患者生命安全[1]。经皮肝穿刺胆道引流（PTCD）是治疗无法行外科根治性切除手术患者的常用姑息性手段，该术式操作简便，支架植入后能引出胆汁，促进肝脏功能恢复，但术后需要长期引流胆汁；而经内镜逆行胰胆管造影（ERCP）术通过机体自然腔道进行，无须穿刺肝脏便能将胆汁引流，易被患者所接受[1-3]。因此，本文就ERCP 术治疗恶性梗阻

性黄疸的临床效果及肝功能指标的影响进行分析，报告如下。1　资料与方法1.1　一般资料

回顾性选择2018年9月-2020年2月于本院接受治疗的44例恶性梗阻性黄疸患者作为研究对象，按照治疗方法分为常规组和微创组，每组22例。纳入标准：（1）影像学检查显示胆囊增大、胆总管变粗和扩张且伴有结石；（2）肝功能指标检测发现总胆红素异常升高；（3）初步评估生存期>3个月。排除标准：（1）心、肝等脏器严重损伤；（2）顽固性腹水；（3）碘对比剂过敏。常规组男14例，女8例；年龄22~80岁，平均（62.24±4.54）岁；低位梗阻16例，高位梗阻6例。观察组男15例，女7例；年龄23~82岁，平均（63.47±5.63）岁；低位梗阻15例，高位梗阻7例。两组一