Therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy for high malignant biliary obstructive jaundice

中华消化内镜杂志 Pub Date : 2019-09-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2019.09.013

Xuan Zhao, Sumin Zhu, L. Miao, Shi Lihong, W. Xiaohong, Yanbin Wang, Jinchen Wang, Simin Guo

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Abstract

Objective To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy(EUS-HG) for patients with high malignant biliary obstructive jaundice. Methods A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group (n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge(PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed. Results (1)The success rates were 100% in both groups. (2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362.15±138.27 μmol/L, 56.85±28.57 μmol/L in the EUS-HG group and 356.47±130.69 μmol/L, 60.93±25.79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896.57±357.29 U/L, 146.59±48.63 U/L in the EUS-HG group and 883.65±364.32 U/L, 151.57±49.73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252.36±38.77 U/L, 60.29±31.57 U/L in the EUS-HG group and 246.26±32.57 U/L, 62.56±32.87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259.37±30.64 U/L, 62.28±26.58 U/L in the EUS-HG group and 242.37±29.52 U/L, 60.28±29.57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52.57±31.95 mg/L, 16.95±8.77 mg/L in the EUS-HG group and 53.42±35.79 mg/L, 25.13±14.77 mg/L in the PTCD group (P 0.05]. (4) The incidence of total complications in the EUS-HG group (20.0%, 4/20) was significantly lower than that in the PTCD group (47.2%, 17/36, P 0.05). (6) The median unblock period of double pig tail plastic stents in EUS-HG group patients was 102 days. Conclusion EUS-HG is a safe and effective method for the treatment of high malignant biliary obstructive jaundice. It can be used as the first choice for treatment after failure of conventional ERCP. Key words: Jaundice, obstructive; Punctures; Drainage, postural; Endoscopic ultrasonography-guided hepaticogastrostomy

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超声内镜引导下肝胃造口术治疗高度恶性胆道梗阻性黄疸的价值

目的探讨内镜下超声引导肝胃吻合术（EUS-HG）治疗恶性胆道梗阻性黄疸的价值。方法纳入2014年1月至2017年12月在南京医科大学第二附属医院和徐州医科大学第二附属医院住院的56例高恶性梗阻性黄疸患者。29名男性和27名女性，中位年龄为72岁（60-82岁）。根据随机数表，患者被随机分为两组，EUS-HG组（n=20）接受EUS-HG治疗，经皮肝穿刺胆管引流术（PTCD）组（n=36）接受PTCD治疗。比较两组的手术成功率、疗效、并发症和手术费用，观察塑料双猪尾支架的中位疏通期。结果（1）两组成功率均为100%。（2）术前和术后一个月的以下水平进行了测试和比较。EUS-HG组的总胆红素水平分别为362.15±138.27μmol/L、56.85±28.57μmol/L，PTCD组为356.47±130.69μmol/L、60.93±25.79μmol/L。EUS-HG组的碱性磷酸酶水平分别为896.57±357.29 U/L、146.59±48.63 U/L和883.65±364.32 U/L、151.57±49.73 U/L。EUS-HG组丙氨酸氨基转移酶水平分别为252.36±38.77 U/L、60.29±31.57 U/L和246.26±32.57 U/L、62.56±32.87 U/L。EUS-HG组天冬氨酸转氨酶水平分别为259.37±30.64 U/L、62.28±26.58 U/L，PTCD组为242.37±29.52 U/L、60.28±29.57 U/L，两组比较差异无统计学意义（P>0.05）。05）。EUS-HG组CRP水平分别为52.57±31.95 mg/L、16.95±8.77 mg/L和53.42±35.79 mg/L、25.13±14.77 mg/L（P 0.05）。结论EUS-HG是治疗高恶性胆道梗阻性黄疸安全有效的方法。可作为常规ERCP失败后的首选治疗方法。关键词：黄疸、梗阻；穿孔；引流，体位；内镜超声引导肝胃造口术

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.