经皮肝穿刺置入胆管支架对胃癌术后复发致胆管梗阻的治疗价值

Value of Percutaneous Transhepatic Insertion of Biliary Stents in Patients with Obstructive Jaundice Secondary to Metastatic Gastric Cancer After Gastrectomy

目的探讨经皮肝穿刺胆管支架置入术（percutaneous transhepatic biliary stent,PTBS）治疗胃癌术后复发致梗阻性黄疸的疗效,分析影响支架通畅时间的危险因素。方法 2008年1月~2013年12月对31例胃癌术后复发致胆道梗阻行PTBS,观察手术成功率、临床症状缓解率、并发症发生情况、支架通畅时间和患者生存时间,分析影响支架通畅时间的危险因素。结果 31例成功行PTBS,27例（87.1%）临床症状缓解,术前总胆红素（150.5±59.8）μmol/L,术后1周下降至（61.8±32.4）μmol/L（t=14.440,P=0.000）。支架中位通畅时间250.9 d（95%CI：205.5~296.4 d）,中位生存时间251.9 d（95%CI：222.6~281.2 d）,12例（44.4%）支架堵塞,未发生其他严重并发症。支架置入术后1周血清总胆红素水平（β=-1.746,95%CI：0.038~0.808,P=0.026）、术后是否化疗（β=-1.692,95%CI：0.039~0.870,P=0.033）是支架通畅时间的影响因素。结论对于胃癌术后复发致胆管恶性梗阻行PTBS安全有效,支架置入术后血清总胆红素水平下降、术后化疗是支架通畅时间的保护因素。

Objective To evaluate the curative effects of percutaneous transhepatic biliary stenting （ PTBS） for obstructive jaundice secondary to metastatic gastric carcinoma after gastrectomy and analyze risk factors for stent patency time . Methods A total of 31 patients who underwent PTBS for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were recruited .The technical and clinical success rates , complications , stent patency , overall survival , and factors associated with stent patency were evaluated. Results Technical success was achieved in all the patients , with a clinical symptom relief rate of 87.1%（27/31）.The mean total bilirubin levels decreased from （150.5 ±59.8） μmol/L before PTBS to （61.8 ±32.4） μmol/L at first week after stent insertion （t=14.440,P=0.000）.The median stent patency time was 250.9 d （95%CI： 205.5 -296.4 d）, while the median survival time was 251.9 d （95%CI：222.6-281.2 d）.The obstruction rate of stent was 44.4%（12/27）, and there were no other serious complications.The total serum bilirubin levels （β=-1.746, 95%CI：0.038-0.808, P=0.026） and chemotherapy after stenting （β=-1.692, 95%CI：0.039-0.870, P=0.033） were predictors for stent patency . Conclusions PTBS is an effective and safe method for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy .The declined serum total bilirubin level and chemotherapy after stenting are protective factors for patency .