超声引导下PTCD治疗晚期MOJ疗效及预后因素分析

Analysis of efficacy and prognostic factors of ultrasound-guided PTCD in the treatment of advanced MOJ

目的:研究超声引导下经皮经肝穿刺胆管引流术(PTCD)治疗晚期恶性梗阻性黄疸(MOJ)临床效果并分析影响患者预后的危险因素。方法:回顾性分析2019年1月至2021年12月西部战区总医院超声引导下PTCD治疗晚期MOJ 90例,详细采集患者病史资料,评估术后7 d肝功能、黄疸、胆管直径改善效果,观察术后并发症发生率及随访1年预后情况,采用多因素Cox回归模型分析影响患者预后的危险因素。结果:超声引导PTCD治疗MOJ 7 d后患者血清丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)和胆管直径均较治疗前降低,血清白蛋白(ALB)水平较治疗前升高,差异均有统计学意义(P<0.05);随访1年中失访5例(5.56%),死亡56例(62.22%),存活29例(32.22%),中位总体生存期(OS)为7.0(95%CI:5.4~8.6)个月;死亡组肝癌、高位梗阻和肝功能Child-Pugh分级C级占比、血清ALT、AST、TBIL和超敏C反应蛋白(hs-CRP)水平均高于存活组,血清ALB水平均低于存活组,差异有统计学意义(P<0.05);多因素Cox回归分析,结果显示肝癌、高位梗阻和肝功能分级C级为死亡危险因素(P<0.05),ALB为死亡保护因素(P<0.05)。结论:超声引导下PTCD治疗晚期MOJ具有良好效果,可有效缓解胆道梗阻并促进肝功能恢复,但总体预后情况仍然较差,肿瘤类型、梗阻部位、肝功能分级和ALB水平均是影响患者预后的重要因素。

Objective:To study the clinical effect of ultrasound-guided percutaneous transhepatic cholangial drainage(PTCD)in the treatment of advanced malignant obstructive jaundice(MOJ)and to analyze the factors affecting the prognosis.Methods:A retrospective study was conducted on 90 patients with advanced MOJ who were treated with ultrasound-guided PTCD in the hospital from January 2019 to December 2021.Clinical data of the patients were collected in detail,and the improvement effects of liver function,jaundice and bile duct diameter were evaluated at the end of 7 days after surgery,and the occurrence of postoperative complications were observed and followed up for one year.A multivariate Cox regression model was used to analyze the factors of prognosis.Results:Seven days after ultrasound-guided PTCD treatment,the levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),and total bilirubin(TBIL)and bile duct diameter of patients with MOJ were reduced,while serum albumin(ALB)level was enhanced as compared with that respectively before treatment(P<0.05).During 1 year of follow-up,5 cases(5.56%)were lost to follow-up,56 cases(62.22%)died and 29 cases(32.22%)survived.The median overall survival(OS)was 7.0 months(95%CI:5.4-8.6).The proportions of liver cancer,high obstruction,and liver function Child-Pugh grade C,as well as the levels of serum ALT,AST,TBIL,and hypersensitive C-reactive protein(hs-CRP)in the death group,were all higher than those in the survival group,while serum ALB level was lower than that in survival group(P<0.05).Multivariate Cox regression analysis showed that liver cancer,high obstruction,and liver function grade C were risk factors for death(P<0.05),and ALB was a protective factor for death(P<0.05).Conclusion:Ultrasound-guided PTCD has a good effect in the treatment of advanced MOJ,and it can effectively relieve biliary tract obstruction and promote liver function recovery,but its prognosis is still poor.Tumor type,obstruction site,liver function grading,and ALB level are all important factors affecting the prognosis of patients.