胆道支架治疗恶性梗阻性黄疸早期疗效及其影响因素

目的探讨胆道支架用于治疗恶性梗阻性黄疸(MOJ)的早期疗效及其影响因素。方法回顾性分析接受经皮肝穿胆管引流(PTCD)+胆道支架植入治疗的232例MOJ患者的临床资料,判断术后早期疗效,并采用单因素分析和Logistic回归分析其影响因素。结果 232例均成功实施PTCD+胆道支架植入术,并置管引流,术后早期疗效显著149例、有效36例、无效47例,总有效率79.74%(185/232)。肿瘤类型、梗阻水平、梗阻长度、肝功能Child-Pugh分级、腹腔积液、肝内病变、远处转移、肿瘤最大径、术前血小板计数(PLT)、CA125水平和术后胆道感染是影响早期疗效的重要因素(P均0.05);肝功能Child-Pugh分级、术前PLT、CA125水平和术后胆道感染是影响早期疗效的独立危险因素(P均0.05)。结论胆道支架植入术在改善MOJ患者肝功能、减黄方面具有一定价值;肝功能Child-Pugh分级、术前PLT、CA125水平和术后胆道感染是影响术后早期疗效的独立危险因素。

Early efficacy and impact factors of biliary stent in treatment of malignant obstructive jaundice

Objective To investigate the early efficacy and impact factors of biliary stent in treatment of malignant obstructive jaundice (MOJ). Methods Clinical data of 232 patients with MOJ who underwent percutaneous transhepatic cholangial drainage (PTCD) and biliary stent implantation were analyzed retrospectively. The early postoperative outcomes were evaluated, and the impact factors of early postoperative outcomes were analyzed using univariate analysis and Logistic regression. Results All 232 patients were successfully treated with PTCD and biliary stent implantation, and the drainage was performed. Among 232 patients, the treatment were markedly effective in 149 cases, effective in 36 cases, whereas ineffective in 47 cases at early postoperative stage, and the total effective rate was 79.74% (185/232). Univariate analysis showed that tumor type, obstruction level, length of obstruction, Child-Pugh grading, ascites, intrahepatic lesions, distant metastasis, tumor size, blood platelet (PLT), CA125 and postoperative biliary tract infection were important factors influencing early efficacy (all P<0.05). Logistic regression showed that Child-Pugh grading, PLT, CA125 and postoperative biliary tract infection were independent risk factors for early efficacy (all P<0.05). Conclusion Biliary stent implantation has certain value in improving liver function and treating jaundice in patients with MOJ. Child-Pugh grading, PLT, CA125 and postoperative biliary tract infection are independent risk factors for early postoperative outcomes.