恶性梗阻性黄疸是一种常见且严重的临床状况,内窥镜逆行胰胆管造影(ERCP)作为其重要的治疗手段,虽然具有较高的成功率,但术后并发症的发生率仍然较为显著。本文综述了恶性梗阻性黄疸患者在ERCP术后可能面临的并发症及其相关危险因素,并探讨其发生机制及处理措施,旨在为临床医生提供对恶性梗阻性黄疸患者ERCP的风险评估及管理策略,以改善患者的术后预后并减少并发症的发生。Malignant obstructive jaundice is a prevalent and severe clinical condition, with endoscopic retrograde cholangiopancreatography (ERCP) serving as a crucial treatment modality. Despite its high success rate, the incidence of postoperative complications remains notably high. This review summarizes the potential complications and associated risk factors that patients with malignant obstructive jaundice may encounter following ERCP, and explores their mechanisms and management strategies. The aim is to provide clinicians with risk assessment and management strategies for ERCP in patients with malignant obstructive jaundice, thereby improving postoperative outcomes and reducing the occurrence of complications.
目的探究经内镜逆行胰胆管造影(ERCP)胆道支架植入与经皮肝穿刺胆道引流术(PTCD)治疗恶性梗阻性黄疸(MOJ)疗效及对免疫功能的影响。方法回顾性分析2021年1月至2022年12月117例MOJ患者资料,根据不同术式分为两组,ERCP组(行ERCP胆道支架植入治疗,n=58)和PTCD组(行PTCD治疗,n=59)。采用SPSS 19.0软件分析数据,手术指标、肝功能、免疫功能等计量资料采用独立样本t检验;梗阻类型、临床疗效、并发症等计数资料以[例(%)]表示,采用χ^(2)检验或秩和检验。P<0.05为差异有统计学意义。结果术后7 d ERCP组患者低位梗阻有效率(92.7%)高于PTCD组(69.2%),高位梗阻有效率(70.0%)低于PTCD组(90.9%)(P均<0.05);两组患者直接胆红素(DBIL)、腺苷脱氨酶(ADA)、碱性磷酸酶(ALP)、谷氨酰基转移酶(GGT)水平均较术前降低,PTCD组低于ERCP组(P均<0.05);T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)水平均较术前降低,但ERCP组高于PTCD组(P均<0.05)。结论ERCP胆道支架植入与PTCD均可有效治疗MOJ,可改善患者肝功能和免疫功能,但PTCD更适用于高位MOJ,ERCP胆道支架植入更适用于低位MOJ。
