关键词: 梗阻性黄疸, 经皮肝穿刺胆道引流术, 内镜逆行性胰胆管造影术, 胰十二指肠切除术

Abstract: Objective To investigate the efficacy of different methods in jaundice reduction for patients with periampullary carcinoma combined with obstructive jaundice. Methods The clinical data of 128 patients with malignant jaundice treated by preoperative biliary decompression before pancreaticoduodenectomy were retrospectively analyzed in Peking Union Medical College Hospital from January 2015 to September 2020. Patients were divided into endoscopic retrograde cholangiopancreatography with stent placement (ERCP) group including 80 cases and percutaneous transhepatic cholangial drainage (PTCD) group including 48 cases according to different methods of jaundice reduction. Serological indicators including total bilirubin (TB) were monitored before jaundice reduction and surgery within one week respectively. The efficacy of jaundice reduction in two groups was compared and further categories were carried out according to the histological types. Results The post jaundice reduction TB(TBpost), TB reduction rate and the reduction adequacy rate (the percentage of postoperative TB≤100 μmol/L) in ERCP group were significantly better than those in PTCD group [(68±45) μmol/L vs. (114±69) μmol/L; 73.9%±16.9% vs. 64.2%±21.2%；83.8% vs. 56.3%]. In patients with duodenal ampullary carcinoma，TBpost, TB reduction rate and the reduction adequacy rate in ERCP group were better than those in PTCD group [(51±20) μmol/L vs. (103±49) μmol/L；78.6%±10.9% vs. 67.2%±14.8%；100% vs. 58.3%]. In patients with distal cholangiocarcinoma, TBpost, TB reduction rate and the reduction adequacy rate of ERCP group were better than those of PTCD group [(76±52) μmol/L vs. (161±51) μmol/L；70.6%±18.5% vs. 56.5%±10.4%；82.1% vs. 11.1%]. Conclusions For patients with malignant obstructive jaundice, stent placement by ERCP is recommended as the first choice for preoperative jaundice reduction, especially for those with ampullary carcinoma or distal cholangiocarcinoma.

Key words: Obstructive jaundice, Percutaneous transhepatic cholangial drainage, Endoscopic retrograde cholangiopancreatography, Pancreatico-duodenectomy