胆道支架植入治疗恶性梗阻性黄疸术后并发症的发生因素分析

Analysis on the Factors of Postoperative Complications of Biliary Stent Implantation for Malignant Obstructive Jaundice

目的:探讨与分析胆道支架植入治疗恶性梗阻性黄疸术后并发症的发生因素。方法:采用回顾性总结研究方法,2015年10月-2019年10月选择在本院重症监护病房(Intensive Care Unit,ICU)诊治的恶性梗阻性黄疸患者112例,所有患者都给予胆道支架植入治疗,记录术后感染并发症发生情况。调查患者的临床资料并进行影响因素分析。结果:112例患者术后发生感染并发症18例,发生率为16.1%,其中胆道感染5例,肺部感染4例,切口感染9例。112例患者术后7 d的血清介素-6(inter-leukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanine transaminase,ALT)值低于术前,CD4^(+)细胞比例高于术前(P<0.05),CD8^(+)细胞比例在手术前后对比差异无统计学意义(P>0.05)。Pearson分析显示术后感染与APACHEⅡ评分、住院时间、糖尿病、吸烟、术前IL-6值、术前CD4^(+)细胞比例存在相关性(P<0.05)。Logistic回归分析显示APACHEⅡ评分、住院时间、糖尿病、吸烟、术前IL-6值、术前CD4^(+)细胞比例导致患者术后感染发生的主要影响因素(P<0.05)。结论:胆道支架植入治疗恶性梗阻性黄疸能抑制炎症因子的释放,促进恢复患者的免疫功能,改善患者的肝功能,但伴随有感染并发症的发生,APACHEⅡ评分、住院时间、糖尿病、吸烟、术前IL-6值、术前CD4^(+)细胞比例是导致患者术后感染发生的主要影响因素。

Objective:To explore and analysis the factors of complications after biliary stent implantation in the treatment of malignant obstructive jaundice.Methods:From October 2015 to October 2019,Used retrospective research methods,112 cases of patients with malignant obstructive jaundice who were diagnosed and treated in the Intensive Care Unit(ICU)of our hospital were selected as the research objects.All patients were given biliary tract stent implantation treatment,recorded postoperative infection complications.Investigated the clinical data of patients and analyzed the influencing factors.Results:There were 18 cases of postoperative infection complications in the 112 patients that the incidence rate were 16.1%,included 5 cases of biliary tract infection,4cases of lung infection,and 9 cases of incision infection.The postoperative 7 d of serum IL-6,TNF-α,AST,and ALT values of 112patients were lower than that of preoperative,and the ratio of CD4^(+)cells were higher than that of preoperative(P<0.05).The ratio of CD8^(+)cells were in the operation ere no statistically significant difference compared between before and after surgery(P>0.05).Pearson analysis showed that postoperative infection were correlated with APACHEⅡscore,hospital stay,diabetes,smoking,preoperative IL-6value and preoperative CD4^(+)cell ratio(P<0.05).Logistic regression analysis showed that APACHEⅡscore,length of stay,diabetes,smoking,preoperative IL-6 value,preoperative CD4^(+)cell ratio were the main influence factors of postoperative infection in patients(P<0.05).Conclusion:Biliary stent implantation in the treatment of malignant obstructive jaundice can inhibit the release of inflammatory factors,promote the recovery of the patient’s immune function,and improve the patient’s liver function,but it is accompanied by the occurrence of infection complications,APACHEⅡscore,hospital stay,diabetes,smoking,The preoperative IL-6 value and the preoperative CD4^(+)cell ratio are the main factors affect the incidence of postoperative infection in patients.