176例梗阻性黄疸病因及诊治分析

摘要

ABSTRACT:Objective To investigate the etiology,diagnosis,treatment and prognosis of ob-structive jaundice.Methods Clinical data of 176 patients with obstructive jaundice were analyzed retrospectively.Among the 176 patients,108 had malignant obstructive jaundice(37 patients with pancreatic cancer(34.26%)),and 68 had benign obstructive jaundice.Twenty patients had biliary tract infection.Eighty-five patients underwent endoscopic retrograde cholangiopancreatography (ERCP),60 patients were treated with percutaneous transhepatic cholangial drainage(PTCD),2 patients were converted to PTCD due to unsuccessful ERCP,12 patients underwent surgery,and 15 were given conservative medical treatment.After treatment,32 patients were discharged from hospital,134 patients achieved significant improvement,and 10 patients died finally.Results Compared with patients with malignant obstructive jaundice,the levels of total bilirubin,alanine aminotransferase,alkaline phosphatase and CA-199 were decreased and the prognosis was im-proved in patients with benign obstructive jaundice(P <0.05 or P <0.01).Compared with PTCD group,the incidence of serious postoperative complications and hospitalization costs were reduced, length of hospital stay was shortened,but surgery costs were increased in ERCP group (P <0.05).Conclusion Malignant tumor is the main cause of obstructive jaundice,and bile duct ob-struction caused by pancreatic carcinoma is one of the most important reasons.The degree of liver damage in patients with malignant obstruction is significantly higher than that in patients with benign obstruction.Surgical operation and interventional therapy have become the palliative treat-ment for malignant obstruction.The curative effect and prognosis of interventional operation in patients with benign obstructive jaundice are better than those in patients with malignant obstruc-tive jaundice.Compared with PTCD,ERCP reduces hospitalization costs,shortens hospital stay and decreases complications,but increases surgery costs.%目的：探讨梗阻性黄疸病因、诊断、治疗和转归。方法回顾性分析176例梗阻性黄疸的临床资料。176例中，恶性梗阻性黄疸108例[原发病中胰腺癌37例（34．26％）占首位]，良性梗阻性黄疸68例；合并胆道感染20例。成功行经内镜逆行性胰胆管造影术（ERCP）85例、行经皮肝穿刺胆道引流术（PTCD）60例，由于 ERCP 未成功改行 PTCD 手术2例，行外科手术12例，予以药物保守治疗15例；自动出院32例，好转134例，死亡10例。结果恶性梗阻性黄疸总胆红素、谷丙转氨酶、碱性磷酸酶、CA-199均高于良性梗阻性黄疸；良性梗阻性黄疸患者的预后明显好于恶性梗阻性黄疸（P ＜0．05或 P ＜0．01）。ERCP 和 PTCD 的手术成功率比较差异无统计学意义（P ＞0．05），PTCD 患者术后严重并发症的发生率高于 ERCP（P ＜0．05）；ERCP 患者平均住院时间比 PTCD 组短，住院总费用比 PTCD 组少，但 ERCP 比 PTCD 手术费用高均（P ＜0．05）。结论梗阻性黄疸以恶性肿瘤为主，胰腺癌造成的胆道梗阻是最重要发病原因之一。恶性梗阻患者的肝损害水平较良性梗阻患者显著。外科手术和介入治疗已成为部分恶性梗阻的姑息性治疗手段。良性梗阻性黄疸比恶性梗阻性黄疸介入手术疗效、转归和预后要好。ERCP 术住院费用、住院时间、并发症均低于 PTCD 术，而手术平均费用略高于 PTCD 术。