恶性梗阻性黄疸介入治疗短期疗效影响因素的研究

Factors influencing the short-term prognosis of interventional therapy for malignant obstructive jaundice:a multivariate analysis

目的:探讨影响恶性梗阻性黄疸经皮肝穿胆道引流(PTBD)联合胆道支架置入术(PTBS)短期疗效的相关因素。方法:分析2004年6月—2009年6月经PTBD和PTBS治疗的恶性梗阻性黄疸患者107例,参照胆红素下降程度和术后30 d内生存情况分为短期治疗有效(91例)和无效(16例)2组,应用卡方检验进行单因素分析,非条件Logistic进行多因素分析。结果:单因素分析显示患者年龄、性别、梗阻时间、梗阻部位、术前胆道感染和肝功能Child-Pugh评分、TBIL、HGB、Cr 9个因素与恶性梗阻性黄疸介入治疗预后相关。多因素分析示术前胆道感染、肝功能Child-Pugh评分≥9分、Cr≥111μmol/L是恶性梗阻性黄疸介入治疗的高危因素。结论:术前胆道感染、肝功能Child-Pugh评分≥9分、Cr≥111μmol/L与恶性梗阻性黄疸短期预后关系密切,对梗阻性黄疸介入治疗的术前评估有重要参考意义。

Objective： To discuss the correlative factors affecting the short-term prognosis in treating malignant obstructive jaundice with percutaneous transhepatic biliary drainage（PTBD） and percutaneous transhepatic biliary stenting（PTBS）.Methods： During the period of June 2004-June 2009,PTBD and PTBS were performed in 107 patients.The clinical date were reviewed and analyzed.According to the reduction degree of serum bilirubin and survival condition in 30 days,the patients were divided into effective Group and ineffective group.Single factor affecting the short-term prognosis was analyzed by using χ2 test and multi-factors were analyzed by using non-conditional logistic regression mode.Results： Single variable analysis showed that age,sex,time of obstruction,way of drainage,preoperative biliary infection,Child-Pugh grade,TBIL,HGB and Cr level were of statistical significance.The logistic regression analysis showed that there were obvious correlation among preoperative biliary infection,Child-grade≥9 and Cr111μmol/L.Conclusion： The infection of the bile duct before operation,Child-grade ≥9 and Cr111μmol/L carry a close relationship with the short-term prognosis of PTBD and PTBS.Therefore,an overall preoperative evaluation for malignant obstructive jaundice is of great importance.