经皮肝穿刺胆管引流术联合胆道支架植入术治疗高位恶性梗阻性黄疸的效果及预后影响因素分析

陈伟伟; 黄坤; 刘锐; 刘承利

doi:10.3969/j.issn.1001-5256.2019.03.021

经皮肝穿刺胆管引流术联合胆道支架植入术治疗高位恶性梗阻性黄疸的效果及预后影响因素分析

DOI: 10.3969/j.issn.1001-5256.2019.03.021

1. 安徽医科大学空军临床学院
2. 空军总医院肝胆外科

基金项目:

首都市民健康项目培育课题(Z131100006813010)；

详细信息

中图分类号: R730.5
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出版历程
- 出版日期: 2019-03-20

Clinical effect of percutaneous transhepatic cholangial drainage combined with biliary stent implantation in treatment of high malignant obstructive jaundice and the influencing factors for prognosis

Clinical College of Air Force, Anhui Medical University

Research funding:

摘要

摘要:
目的探讨经皮肝穿刺胆管引流术（PTCD）联合胆道支架植入术治疗高位恶性梗阻性黄疸（MOJ）的效果及影响生存期的危险因素。方法回顾性分析解放军空军总医院肝胆外科2015年6月-2017年6月收治的92例高位MOJ患者临床资料。符合正态分布的计量资料两组间比较采用t检验,多组间比较采用方差分析,进一步两两比较采用SNK-q检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。采用受试者工作特征曲线（ROC曲线）明确影响生存期指标的最佳截断值,根据最佳截断值进行分组,采用Kaplan-Meier法进行生存分析。多因素Cox风险模型分析明确影响患者生存期的独立危险因素。结果所有患者均获得随访,随访时间1～10个月,中位随访时间6个月。随访期间56例患者死亡,36例患者存活,中位生存期（OS）为6个月,随访末期生存率39. 1%,半年生存率44. 6%。14例患者出现术后并发症,并发症发生率为15. 2%。术后3 d及术后1周的TBil、DBil、ALT、AST复查结果显示,上述指标水平显著下降且差异均有统计学意义（F值分别为206. 264、1...
- 黄疸,阻塞性 /
- 引流术 /
- 预后 /
- 危险因素
Abstract:
Objective To investigate the clinical effect of percutaneous transhepatic cholangial drainage ( PTCD) combined with biliarystent implantation in the treatment of high malignant obstructive jaundice ( MOJ) and the risk factors for survival time. Methods A retro-spective analysis was performed for the clinical data of 92 patients with high MOJ who were admitted to Department of Hepatobiliary Surgeryin Air Force General Hospital, PLA, from June 2015 to June 2017. The t-test was used for comparison of normally distributed continuousdata between two groups; an analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for furthercomparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data betweentwo groups. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was used to determine the optimal cut-off values of influencing factors for survival time; the patients were divided into groups accord-ing to the optimal cut-off values, and the Kaplan-Meier method was used for survival analysis. The multivariate Cox proportional hazardsmodel was used to identify the independent influencing factors for survival time. Results All patients were followed up for a median time of6 months ( range 1-10 months) . A total of 56 patients died and 36 survived during follow-up, with a median survival time of 6 months, asurvival rate of 39. 1% at the end of follow-up, and a half-year survival rate of 44. 6%. Of all 92 patients, 14 experienced postoperativecomplications, resulting in an incidence rate of complications of 15. 2%. At 3 days and 1 week after surgery, there were significant reduc-tions in total bilirubin ( TBil) , direct bilirubin, alanine aminotransferase ( ALT) , and aspartate aminotransferase ( F = 206. 264, 106. 161, 86. 332, and 166. 857, all P < 0. 05) . The ROC Curve was used to analyze the data, TBil had a sensitivity of 95. 12% and a specificity of46. 15% at the optimal cut-off value of 112. 9 μmol/L; ALT had a sensitivity of 92. 68% and a specificity of 31. 58% at the optimal cut-off value of 210 U/L; albumin had a sensitivity of 68. 29% and a specificity of 58. 33% at the optimal cut-off value of 35. 7 g/L; red blood cell count had a sensitivity of 60. 98% and a specificity of 69. 23% at the optimal cut-off value of 3. 56 × 1012/L. Child-Pugh class, TBil, and ALT showed a significant difference in predicting overall survival ( all P < 0. 05) . The multivariate Cox proportional hazards model showed that Child-Pugh class C was an independent influencing factor for survival time after PTCD combined with biliary stent implantation. Conclusion PTCD combined with biliary stent implantation has a good clinical effect in the treatment of patients with MOJ, but preoperative liver function has a great impact on survival time. Therefore, liver function should be observed dynamically to guide clinical treatment, in order to prolong the survival time of such patients.
- jaundice, obstructive /
- drainage /
- prognosis /
- risk factors

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参考文献(19)

[1] XU XJ, LI JJ, WU J, et al. A systematic review and meta-a-nalysis of intraluminal brachytherapy versus stent alone in thetreatment of malignant obstructive jaundice[J]. Cardiovasc In-ter Radiol, 2018, 41 (2) :206-217.

[2] MA J, LUO J, GU J, et al. Malignant obstructive jaundicetreated with intraluminal placement of Iodine-125 seedstrands and metal stents:An analysis of long-term outcomesand prognostic features[J]. Brachytherapy, 2018, 17 (4) :689-695.

[3] WANG L, YU WF. Obstructive jaundice and perioperative man-agement[J]. Acta Anaesthesiol Taiwan, 2014, 52 (1) :22-29.

[4] XU G. Clinical effect of biliary metal stent implantation via en-doscopic retrograde cholangiopancreatography in treatment ofunresectable malignant extrahepatic biliary obstruction[J]. JClin Hepatol, 2018, 34 (2) :337-340. (in Chinese) 徐刚.经内镜逆行胰胆管造影胆道金属支架置入治疗不可切除肝外胆道恶性梗阻的效果观察[J].临床肝胆病杂志, 2018, 34 (2) :337-340.

[5] CHEN Y, WANG XL, YAN ZP, et al. The use of125I seed strands forintraluminal brachytherapy of malignant obstructive jaundice[J].Cancer Biother Radiopharm, 2012, 27 (5) :317-323.

[6] YAO GL, JIANG Y, ZHAO YX, et al. Comparative efficacy ofpalliative biliary enteric extraction and percutaneous biliarystenting under ultrasound guidance in the treatment of malig-nant obstructive jaundice[J]. J Clin Exp Med, 2018, 22 (17) :2430-2433. (in Chinese) 姚广力, 江怡, 赵云歆, 等.恶性梗阻性黄疸患者经皮经肝胆管引流途径胆道支架置入与姑息性胆肠内引流的疗效比较[J].临床和实验医学杂志, 2018, 22 (17) :2430-2433.

[7] CHEN TS, LI SY. Percutaneous transhepatic cholangial drain-age for the comprehensive treatment of malignant biliary ob-struction[J]. Clin J Med Offic, 2017, 45 (9) :881-883. (inChinese) 陈挺松, 李淑英.恶性胆道梗阻经皮肝穿综合治疗[J].临床军医杂志, 2017, 45 (9) :881-883.

[8] KIKUYAMA M, SHIRANE N, KAWAGUCHI S, et al. New 14-mm diameter Niti-S biliary uncovered metal stent for unresect-able distal biliary malignant obstruction[J]. World J Gastroint-est Endosc, 2018, 10 (1) :16-22.

[9] WANG X, LI XC. Rsearch advances in palliative treatment ofcholangiocarcinoma[J]. J Clin Hepatol, 2016, 32 (5) :1022-1025. (in Chinese) 王荇, 李相成.胆管癌姑息治疗的研究进展[J].临床肝胆病杂志, 2016, 32 (5) :1022-1025.

[10] XU C, SHI HB, LIU S, et al. Transhepatic biliary drainage forthe treatment of low position malignant obstructive jaundice:An analysis of related factors influencing the prognosis[J]. JVasc Interv Radiol, 2013, 125 (3) :360-367.

[11] CHANG ZK, KOU ZP, LI SX, et al. To evaluate the correlationbetween the change of immune system function before and af-ter the treatment of malignant obstructive type jaundice treatedwith biliary stent[J]. Eur Rev Med Pharmaco, 2018, 22 (6) :1638.

[12] TANG K, SUI LL, XU G, et al. Effects of different palliativejaundice reducing methods on immunologic functions in pa-tients with advanced malignant obstructive jaundice[J]. Anti-cancer Res, 2017, 37 (8) :4665-4670.

[13] ADANG S, RINO AG, MURDANI A, et al. Changes in tumornekrosis factor alpha and interleukin 6 levels in patients withobstructive jaundice due to pancreatobiliary cancer who under-went biliary drainage[J]. Tijoghade, 2016, 17 (2) :92-98.

[14] WANG WJ, YU CH. Improvement in liver function in patientswith malignant obstructive jaundice after endoscopic biliarymetallic stent drainage[J]. J Clin Hepatol, 2015, 31 (8) :1295-1298. (in Chinese) 王文君, 于聪慧.胆道支架引流术对恶性梗阻性黄疸患者肝功能的影响[J].临床肝胆病杂志, 2015, 31 (8) :1295-1298.

[15] ZHANG C, YANG YL, WU P, et al. Prevention and treatmentof complications for full-covered self-expanding removablemetal stents in malignant obstructive jaundice[J]. Natl Med JChina, 2015, 95 (6) :416-419. (in Chinese) 张诚, 杨玉龙, 吴萍, 等.全覆膜自膨式可回收金属支架治疗恶性梗阻性黄疸的并发症及防治策略[J].中华医学杂志, 2015, 95 (6) :416-419.

[16] DELDEN OMV, LAMERIS JS. Percutaneous drainage and stent-ing for palliation of malignant bile duct obstruction[J]. Eur Radi-ol, 2008, 18 (3) :448-456.

[17] INAL M, AKGL E, AKSUNGUR E, et al. Percutaneous self-expandable uncovered metallic stents in malignant biliary ob-struction:Complications, follow-up and reintervention in 154patients[J]. Acta Radiol, 2015, 44 (2) :139-146.

[18] ZHANG GY, LI WT, PENG WJ, et al. Clinical outcomes andprediction of survival following percutaneous biliary drainagefor malignant obstructive jaundice[J]. Oncol Lett, 2014, 7 (4) :1185-1190.

[19] HYUN H, CHOI SY, KIM KA, et al. Safety and efficacy of per-cutaneous biliary covered stent placement in patients with ma-lignant biliary hilar obstruction; correlation with liver function[J]. Cardiovasc Intervent Radiol, 2016, 39 (9) :1298-1305.

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