摘要
目的 系统评价经皮经肝穿刺胆道引流术(percutaneous transhepatic cholangial drainage, PTCD)与内镜下逆行性胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)两种引流方式对恶性梗阻性黄疸(malignant obstructive jaundice, MOJ)的临床疗效和手术安全性。方法 通过机算机检索CNKI、VIP、CBM、万方、Cochrane、PubMed等数据库,收集国内外关于使用PTCD与ERCP对MOJ进行治疗的相关文献。应用RevMan 5.4.1进行数据分析。对比两种引流方法在手术的成功率、黄疸的缓解率、临床疗效、手术前和手术后相关肝功能指标变化(包括ALT、AST、TBIL、DBIL)以及手术后并发症的发生率。结果 共纳入15篇相关文献,共有病例数1 235例。Meta分析结果显示:两者的手术成功率差异无统计学意义(P=0.02);低位梗阻患者在行ERCP后黄疸缓解率较高(P=0.006)、临床疗效更好(P=0.0005),高位梗阻患者在行PTCD后黄疸缓解率较高(P<0.0001)、临床疗效更好(P<0.0001),总体的黄疸缓解率和临床疗效在进行这两种引流方法后的数据差异无统计学意义(P=0.16、0.08);两组的手术前和手术后的ALT下降值、AST下降值、TBIL下降值、DBIL下降值对比和术后的并发症发生率情况对比,差异无统计学意义(P>0.05)。结论 通过使用ERCP或PTCD这两种介入手段均可以有效缓解胆道梗阻并改善肝功能。低位梗阻患者行ERCP临床疗效更优,高位梗阻患者行PTCD临床疗效更优。
Objective To systematically evaluate the clinical efficacy and surgical safety of percutaneous transhepatic cholangial drainage(PTCD) and endoscopic retrograde cholangiopancreatography(ERCP) in the treatment of malignant obstructive jaundice(MOJ).Methods CNKI, VIP, CBM, WanFang, Cochrane and PubMed were searched, and literatures about the treatment of MOJ with PTCD and ERCP were collected at home and abroad. RevMan 5.4.1 was used for data analysis. The rate of success, jaundice remission rate, clinical efficacy, changes of liver function indexes(ALT, AST, TBIL, DBIL) before and after surgery, and the rate of complications were compared between the two drainage. Results About 15 literatures were included in this study, including 1 235 cases. There was no difference in the success rate of drainage between the two groups(P=0.02). Patients with low obstruction had higher jaundice remission rate(P=0.006) and better clinical efficacy(P=0.0005) after ERCP, while patients with high obstruction had higher jaundice remission rate(P<0.0001) and better clinical efficacy(P<0.0001) after PTCD. There was no significant difference in the overall jaundice remission rate and clinical efficacy between the two drainage methods(P=0.16, 0.08). The comparison of the decline of ALT, AST, TBIL and DBIL before and after surgery and the incidence of postoperative complications between the two groups showed no significant statistical significance(P>0.05).Conclusion ERCP or PTCD can effectively relieve biliary obstruction and improve liver function. Patients with low obstruction received ERCP and patients with high obstruction received PTCD have better clinical efficacy.
作者
张睿
武希润
丁鹏
ZHANG Rui;WU Xirun;DING Peng(Shanxi Medical University,Taiyuan 030001;Department of Gastroenterology,the Second Hospital of Shanxi Medical University,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第2期202-211,共10页
Chinese Journal of Gastroenterology and Hepatology
关键词
恶性梗阻性黄疸
经皮经肝穿刺胆道引流术
内镜下逆行性胰胆管造影
Malignant obstructive jaundice
Percutaneous transhepatic cholangial drainage
Endoscopic retrograde cholangiopancreatography
