Comparison of efficacy between PTCD and ERCP+ENBD in palliative treatment of malignant obstructive jaundice

doi:10.3877/cma.j.issn.2095-3232.2021.06.007

Abstract

Abstract:

Objective

To compare the efficacy of percutaneous transhepatic cholangial drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) + endoscopic nasobiliary drainage (ENBD) in the palliative treatment of malignant obstructive jaundice.

Methods

Clinical data of 68 patients with malignant obstructive jaundice admitted to the Second Affiliated Hospital of Kunming Medical University from December 2018 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 37 patients were male and 31 female, aged from 27 to 85 years, with a median age of 63 years. All patients were divided into the PTCD (n=36) and ERCP+ENBD groups (n=32). The jaundice remission rate and perioperative conditions between two groups were observed. The length of hospital stay and hospitalization expense between two groups were compared by t test. The rate comparison was conducted by Chi-square test or Fisher's exact probability test.

Results

After treatments, the clinical symptoms of jaundice, skin itching and liver function of patients were improved in two groups. In the PTCD group, the remission rate of high-position obstructive jaundice was 91%(20/22), significantly higher than 50%(6/12) in the ERCP+ENBD group (χ²=7.222, P<0.05). In the ERCP+ENBD group, the remission rate of low-position obstructive jaundice was 95%(18/19), significantly higher compared with 64%(9/14) in the PTCD group (χ²=5.024, P<0.05). The overall incidence of postoperative complications in the PTCD and ERCP+ENBD groups were 17%(6/36) and 32%(10/31), respectively. No statistical significance was noted between two groups (χ²=2.228, P>0.05). In the ERCP+ENBD group, the incidence of postoperative acute pancreatitis was 13%(4/31), significantly higher compared with 0 in the PTCD group (P=0.026). In the PTCD group, the length of hospital stay and hospitalization expense were (15.6±2.7) d and (2.5±0.4)×10⁴ yuan, significantly less than (18.7±2.3) d and (2.7±0.3)×10⁴ yuan in the ERCP+ENBD group (t=-5.140, -2.910; P<0.05).

Conclusions

Both PTCD and ERCP+ENBD are effective treatments for malignant obstructive jaundice. PTCD is more suitable for patients with high-position obstructive jaundice, whereas ERCP+ENBD is recommended for those with low-position obstructive jaundice. Both operations have its own advantages and limitations. Conditions of the patients should be considered when making therapeutic option, which can only bring clinical benefits to the patients.

Key words: Drainage, Percutaneous transhepatic cholangial drainage, Cholangiopancreatography, endoscopic retrograde, Endoscopic nasobiliary drainage, Jaundice, obstructive, Comparative effectiveness research

Zhitang Guo, Jinfeng Bai, Min Sun, Yishan Teng, Shisi Li, Zhangbin Chen. Comparison of efficacy between PTCD and ERCP+ENBD in palliative treatment of malignant obstructive jaundice[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(06): 564-569.

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References 22

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组别	例数	年龄（岁，±s）	性别（例）		原发病（例）			梗阻部位（例）		梗阻时间（d，±s）
组别	例数	年龄（岁，±s）	男	女	胰头癌	壶腹癌	胆管癌	高位	低位	梗阻时间（d，±s）
PTCD组	36	61±14	17	19	9	4	23	22	14	18±5
ERCP+ENBD组	32	62±10	20	12	13	5	14	13	19	19±5
统计值		t=-0.420	χ²=1.594		χ²=2.802			χ²=2.846		t=-0.645
P值		0.676	0.207		0.246			0.091		0.521

组别	例数	年龄（岁，±s）	性别（例）		原发病（例）			梗阻部位（例）		梗阻时间（d，±s）
组别	例数	年龄（岁，±s）	男	女	胰头癌	壶腹癌	胆管癌	高位	低位	梗阻时间（d，±s）
PTCD组	36	61±14	17	19	9	4	23	22	14	18±5
ERCP+ENBD组	32	62±10	20	12	13	5	14	13	19	19±5
统计值		t=-0.420	χ²=1.594		χ²=2.802			χ²=2.846		t=-0.645
P值		0.676	0.207		0.246			0.091		0.521

组别	例数	术前
组别	例数	TB（μmol/L）	DB（μmol/L）	ALT（U/L）	ALP（U/L）	GGT（U/L）
PTCD组	36	340±107	239±38	215±40	526±92	522±95
ERCP+ENBD组	32	381±91	242±41	203±23	534±68	535±106
t值		-1.682	-0.305	1.575	-0.705	-0.525
P值		0.097	0.761	1.121	0.380	0.601
组别	例数	术后7 d
组别	例数	TB（μmol/L）	DB（μmol/L）	ALT（U/L）	ALP（U/L）	GGT（U/L）
PTCD组	36	139±29	113±27	69±14	198±38	203±34
ERCP+ENBD组	31^a	147±31	116±32	65±10	210±49	198±41
t值		-1.104	-0.370	1.374	-1.131	0.564
P值		0.274	0.713	0.174	0.262	0.575

组别	例数	术前
组别	例数	TB（μmol/L）	DB（μmol/L）	ALT（U/L）	ALP（U/L）	GGT（U/L）
PTCD组	36	340±107	239±38	215±40	526±92	522±95
ERCP+ENBD组	32	381±91	242±41	203±23	534±68	535±106
t值		-1.682	-0.305	1.575	-0.705	-0.525
P值		0.097	0.761	1.121	0.380	0.601
组别	例数	术后7 d
组别	例数	TB（μmol/L）	DB（μmol/L）	ALT（U/L）	ALP（U/L）	GGT（U/L）
PTCD组	36	139±29	113±27	69±14	198±38	203±34
ERCP+ENBD组	31^a	147±31	116±32	65±10	210±49	198±41
t值		-1.104	-0.370	1.374	-1.131	0.564
P值		0.274	0.713	0.174	0.262	0.575

组别	例数	并发症					满意度
组别	例数	出血	胆漏	胆道感染	急性胰腺炎	导管脱落	很满意	满意
PTCD组	36	2	2	1	0	1	12	14
ERCP+ENBD组	31^a	1	0	5	4	0	13	8
χ²值		0.211	-	3.642	-	-	1.311
P值		0.646	0.183	0.056	0.026	0.350	0.519

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