经皮肝穿刺胆管引流术致肝动脉损伤的危险因素分析

Risk factors of hepatic artery injury during percutaneous transhepatic biliary drainage

目的探讨经皮肝穿刺胆管引流(PTBD)术中肝动脉损伤的发生率及危险因素。方法回顾性分析2002年4月至2020年12月1446例在北京大学人民医院接受PTBD术的患者的临床资料。结果1446例PTBD手术中,共发生肝动脉损伤7例,发生率为0.48%。所有病例均采用透视引导穿刺,其中未成功置入引流管者7例(0.48%),发生肝动脉损伤1例,置入1根引流管者1314例(90.87%),发生肝动脉损伤5例,置入2根引流管者125例(8.65%),发生肝动脉损伤1例。不能成功置入引流管会增加肝动脉损伤的发生率(OR=0.06,95%CI 0.01~0.71,P=0.026)。穿刺针针尖为斜面者1430例(98.89%),发生肝动脉损伤5例,针尖为三棱形者16例(1.11%),发生肝动脉损伤2例。三棱形针尖会增加肝动脉损伤的发生率(OR=55.57,95%CI 6.84~451.38,P<0.001)。结论肝动脉损伤是PTBD较少见的并发症,采用三棱形针尖穿刺针及不能成功置入引流管是肝动脉损伤的危险因素。

Objective To investigate the incidence and risk factors of hepatic artery injury during percutaneous transhepatic biliary drainage(PTBD).Methods From Apr 2002 to Dec 2020,the clinical data of 1446 patients undergoing PTBD were retrospectively analyzed.Results Hepatic artery injury occurred in 7 cases,with an incidence of 0.48%.Fluoroscopy guided puncture was used in all cases.In those 7 cases(0.48%)a drainage catheter was failed to put in place after multiple attempts,hepatic artery injury occurred in 1 case;One drainage catheter was inserted in 1314 cases(90.87%),hepatic artery injury occurred in 5 cases;One hundred and twenty-five cases(8.65%)were implanted with two drainage catheter,and 1 case had hepatic artery injury.Failure to successfully insert the drainage catheter increase the incidence of hepatic artery injury(OR=0.06,95%CI 0.01-0.71,P=0.026).There were 1430 cases(98.89%)with oblique needle tip and 5 cases had hepatic artery injury;There were 16 cases(1.11%)with triangular needle tip and 2 cases had hepatic artery injury.Triangular needle tip increased the incidence of hepatic artery injury(OR=55.57,95%CI 6.84-451.38,P<0.001).Conclusion Hepatic artery injury is a rare complication of PTBD.The use of triangular needle and the failure of drainage were the risk factors of hepatic artery injury.