关键词: 低位胆道梗阻, 经皮肝穿刺肝总管置管引流术, 一步法, 二步法

Abstract: Objective To investigate the efficacy and complications of one-step and two-step ultrasound-guided percutaneous transhepatic hepatic duct drainage (PTHD) in the treatment of advanced low-level biliary obstruction.Methods A total of 112 patients with advanced low-level biliary obstruction who underwent palliative surgery for reducing jaundice in the hospital from January 2019 to July 2023 were selected,and divided into the one-step group and the two-step group according to the principle of complete randomization (grouped by random number table method).The one-step group (n=56) underwent one-step PTHD,while the two-step group (n=56) underwent two-step PTHD.Surgery related indicators,serum total bilirubin (TBIL),alkaline phosphatase (ALP),alanine transaminase (ALT),the incidence of postoperative complications,and satisfaction were compared between the two groups.Results There was no difference in intraoperative blood loss[(2.96±0.50)ml vs. (3.02±0.53)ml],drainage volume in 48 hours after surgery[(555.84±90.51)ml vs. (560.52±104.23)ml]between the two groups(P>0.05).Operation time and postoperative VAS score of the one-step group were significantly shorter/lower than those of the two-step group[(32.50±4.26) min vs. (36.43±3.58) min,(3.72±1.57) points vs.(4.53±1.34) points],and the success rate of puncture was significantly higher than that in the two-step group(96.43% vs.76.69%),with statistically significant differences (P＜0.05).After treatment,the levels of TBIL,ALP and ALT in the two groups were significantly reduced (P＜0.05),but there was no statistically significant difference between the groups (P>0.05).There was no statistically significant difference in the incidence of complications between the two groups (3.57% vs.7.14%,Fisher’s exact probability=0.679).The satisfaction rate in the one-step group was significantly higher than that in the two-step group (94.64% vs.75.00%),with a statistically significant difference (P＜0.05).ConclusionThe operation time of one-step PTHD is shorter and the success rate of puncture is higher.In addition,patients undergoing one-step PTHD have milder pain,and are more satisfied.

Key words: low-level biliary obstruction, percutaneous transhepatic drainage, one-step method, two-step method