关键词: 恶性梗阻性黄疸, 经内镜逆行性胰胆管造影术, 经皮肝穿刺胆道引流术, 胆道金属支架引流术, 疗效, 安全性

Abstract: Objective To evaluate the therapeutic efficacy and safety profile of two distinct biliary metal stent drainage(EMBE) methods in the management of malignant obstructive jaundice (MOJ).Methods A total of 112 patients diagnosed with MOJ between January 2019 and September 2021 were enrolled in this study. Patients were evenly allocated into either observation group or control group, each containing 56 participants. The observation group underwent EMBE facilitated by endoscopic retrograde cholangiopancreatography (ERCP), whereas the control group received percutaneous transhepatic biliary drainage (PTCD). Various metrics, including perioperative markers, inflammatory and immunological profiles, liver function tests, indices of therapeutic effecacy and safety, were meticulously evaluated.Results There were no statistically significant differences between the two groups in terms of operative time and intraoperative blood loss (P>0.05). Patients in the ERCP group had shorter initial out-of-bed times(29.46±6.30 h), shorter first hospotal stays(4.52±0.76 d), and lower total hospitalization costs(3.93±0.47 million yuan) compared to those in the PTCD group (32.75±6.25 h, 5.19±0.85 d and 4.46±0.58 million yuan, respectively; t=6.527, 6.293, 6.043, all P<0.05). After one week of treatment, both groups exhibited significant reductions in NLR, TNF-α and sIL-2R levels compared to pre-treatment baselines (P<0.05). However, post-treatment levels were not significantly different between the groups(P>0.05). Liver function indicators, including TBIL, ALP and ALB, were significantly improved in the ERCP group(146.59±24.83 μmol/L, 168.34±31.65 U/L, 32.18±2.49 g/L) compared to the PTCD group(180.27±31.54 μmol/L, 201.87±39.25 U/L and 30.83±2.27 g/L; t=8.023, 7.495, 5.876, all P<0.05). No significant differences were observed in surgical success rates or total remission rates between the two groups (P>0.05). The ERCP group had lower remission rate of high obstruction (53.33%) compared to the PTCD group (85.71%), but a higher remission and one-year survival rate for low obstruction(90.24% and 30.36%, respectively) compaared to the PTCD group (64.29% and 16.07%; χ²=5.276, 5.481, 4.297, P<0.05). In terms of complications, the The ERCP group had a higher incidence of PEP(7.14%), compared to the PTCD group (0%). The incidence of biliary tract infection was 3.57% in the ERCP group versus 7.14% in PTCD group, with the difference being statistically significant (χ²=5.239, 4.351, both P<0.05). No significant differences were noted in the overalll incidence rates of biliary bleeding, biliary leakage, stent displacement, slippage, or other complications between the two groups (P>0.05).Conclusion Both ERCP and PTCD demonstrate robust efficacy and a high safety profile in treating patients with MOJ, complicated by EMBE. Specifically, ERCP is particularly advantageous for treatling lower MOJ cases, whereas PTCD exhibits greater suitability for addresing upper MOJ conditions.

Key words: MOJ, ERCP, PTCD, EMBE, Curative effect, Security